Author: Leonie Hellwich
Artist: Zach Ng
Editor: Evelyn Nguyen
Post-traumatic stress disorder (PTSD) can be described as one of the most impactful disorders known nowadays that presents various challenges for clinical practitioners. The disorder usually arises by experiencing or witnessing an anxiety-inducing traumatic event, characterised with coping difficulties including panic attacks, flashbacks, intrusive memories and nightmares. Intrusive memories are described as emotional impressions based on other senses that come to mind involuntarily and often transport the affected individual back to the time of the traumatic event, leading to the illusion of a persistently active threat. The term panic attacks refers to spells of sudden and intense anxiety which can take forms of difficulty with breathing, shaking or hyperventilating.
Common causes of PTSD include abuse, assault, severe accidents, or war events. Having PTSD can affect various areas of life and have grave consequences for the affected individual, for instance result in distancing themselves from friends and families, developing irrational fears of everyday behaviours or struggling to remain optimistic about the future.
Thus, it becomes evident how crucial it is to develop an effective strategy to tackle PTSD symptoms and allow affected individuals to continue their life as undisturbed as possible. Unfortunately for the 4% estimated to be affected by PTSD in the United Kingdom, the current field lacks broader availability of therapeutic approaches that focus on trauma. Exploring new treatment options is therefore essential.
While previously reviewed as not recommended for PTSD treatment, a recent paper by Hennessy et al. (2022) questions those past results. They are concentrating on the trend for PTSD patients to have low levels of the hormone cortisol, usually associated with stress. This may be associated with a decreased capacity to react to and maintain physical functioning during episodes of heightened stress. Since previous studies obtained unclear and conflicting results also in regards to sex differences in the effectiveness of hormone-based PTSD treatment, Hennessy et al. (2022) investigated the effect of hydrocortisone on men and women after they had experienced analogue trauma in the form of a trauma film, consisting of two scenes that showed extreme violence. Hydrocortisone refers to the hormone cortisol when administered to an individual as tablets.
To accurately test the impact of hydrocortisone, it was crucial to have a control group, a group that receives a void medication instead of the drug which should not cause any effect. In research like this, one needs to factor in the placebo effect, which describes the phenomenon where people who expect an effect after taking medication will feel an effect or notice an effect even when the medication has none. If the observed effect on the experimental group exceeds the effect on the control group, it can be assumed that the medication has a valid and significant effect. Hydrocortisone or the placebo were randomly administered to the participants one hour after seeing the film.
Firstly, participants in the study completed various self-report questionnaires assessing their characteristics and whether they showed symptoms of personality disorders. Following the exposure to the film the participants were instructed to complete online diaries which included reports of their intrusive memories for seven days. Each memory was to be briefly described and the number of its repetitions on the day reported. Additionally, their vividness and the distress level they caused were rated on a scale.
The results obtained in the study are highly interesting. Measurements of heart rate and blood pressure during the day of the trauma film exposure showed that both increased from pre-film to post-film measurement, but recovered within an hour. Administering hydrocortisone was reflected by increased levels of cortisol in the participants’ saliva. While accounts of immediately recorded intrusive memories in the post-film hour did not differ between the groups, meaningful results were obtained when testing the effects of time, sex and drug (hydrocortisone or placebo) on the number of memory intrusions. The hydrocortisone group reported a faster reduction of intrusive memories, especially between day 1 and day 2 after watching the trauma film. Vividness and distress, nevertheless, decreased slightly faster in the control group. Now, what conclusions can we draw from these observations? The accelerated decline in memory intrusions in the hydrocortisone group mark this medication as potentially promising in the development of an effective PTSD treatment. Evidence to highlight the role of female sex hormones in memory functioning in men and women was observed and should be further investigated.
Of course, the results of this study do not allow us to apply them to real-life scenarios. Compared to the trauma response that was artificially created by exposing participants to the trauma film, real-life trauma is highly individual and complex., PTSD can stem from extremely diverse situations and experiences, and is therefore difficult to sum up or develop a suitable treatment that can be generalised to all possible causes. The convergence between the impact on healthy participants with artificially created trauma and the impact on clinical participants remains unclear.
What can we take away from this paper? Treating PTSD with prescribed hydrocortisone appears promising in terms of reducing memory intrusions early on. Which type of memory is affected by the medication, the impact on clinical populations, and the effectiveness on real-life complex trauma remains to be investigated in future studies, which could lead to novel and life-changing improvements in PTSD treatment.