NEW YORK, Nov. 30 (UPI) — Cadets whose stress hormone cortisol increased the most at waking were more likely to show stress symptoms later as police officers, U.S. researchers say.

Dr. Charles Marmar of the new York University’s Langone Medical Center, in collaboration with the San Francisco VA Medical Center and the University of California, San Francisco, assessed 296 police recruits during academy training for salivary cortisol at first awakening and after 30 minutes.

The difference between the two levels is known as cortisol awakening response. the study found the greater cortisol awakening response during academy training predicted greater peritraumatic dissociation and acute stress disorder symptoms over the first three years of police service.

Police academy recruits who showed the greatest rise in cortisol after waking up were more likely to show post-traumatic stress disorder in response to trauma years later as police officers, Marmar said.

“This study is significant as a potential indicator in determining when people may exhibit stress symptoms in the future,” Marmar said in a statement.

“Few studies have prospectively examined the relationships among pre-exposure hypothalamic-pituitary-adrenal activity, acute stress reactions and PTSD. the findings may lead us to new insights on how to identify those who are at a higher risk of PTSD.”

The study is to be published in Biological Psychiatry.

Anxiety Introduction Anxiety is a natural human feature of behavior and is an inherent part of our species. The word “anxiety” is derived from the word “anxious”, which came from a meaning of being tormented. Anxiety in itself is then known to be a type of self-torment which is brought up as a defensive response to a given situation. Anxiety is so common that almost everyone experiences it in some form every single day. This anxiety is not a problem, it is only when anxiety begins to creep into places where it actually has no real justification that it becomes a problem and is termed to be a ‘disorder’.

Anxiety Disorders there are a range of different types of anxiety disorders which may be treated differently. The most common anxiety disorders include:

• Obsessive Compulsive Disorder (OCD)
• Generalized Anxiety Disorder (GAD)
• Social Phobia
• Panic Attacks
• Agoraphobia
• Post Traumatic Stress Disorder(PTSD)
• Specific Phobias

Common Anxiety Causes Causes of anxiety disorders are rarely ever set in stone and can be due to a range of different things such as:

• Genetic Predisposition – Some types of anxiety disorders such as Generalized Anxiety Disorder (GAD) have been found to run in families and are thought to perhaps be inherited through a gene which makes people more prone to become anxious.
• Stress – High levels of stress or seemingly endless stressful situations have been proven as a cause of anxiety disorders. Disorders such as Post Traumatic Stress Disorder (PTSD) are specifically found to have been caused by stressful and traumatizing events.
• Sudden life changes – Death of loved ones and other sudden, shocking changes in everyday life can play a large role in the development of an anxiety disorder.

There may also be a range of internal and external factors which are involved in the development of each specific case of anxiety disorders. it is important to talk about the things you think might be causing your anxiety problems with someone who will listen and understand where you are coming from. This can help you to resolve your own feelings and to better understand why you are going through a tough time.

Common Symptoms of Anxiety Symptoms of anxiety disorders may range vastly depending on the type of anxiety. Some very common anxiety symptoms include:

Natural Anxiety Treatments Relaxation techniques Learning how to relax your body and release pent up tension which contributes to anxiety can be incredibly helpful in treating the root cause of anxiety disorders. Some good relaxation techniques for anxiety include:

* Progressive muscle relaxation

* Abdominal breathing

* Relaxation exercises

Cognitive therapy The use of cognitive therapy is primarily focused on changing patterns of thinking and subconscious beliefs which are triggering or may be associated with the experienced anxiety. For example, a person suffering from social phobia anxiety may benefit from changing beliefs about the way people see him/her. If the person says to themselves, “I am boring” it is dis-empowering and may worsen the condition. If the person can begin to change their beliefs and surrounding thought patterns, it becomes much easier to change for the good.

Cognitive therapy includes rational ‘self-talk’, reality testing, cognitive challenging, attention training and cognitive restructuring. This includes monitoring your self-talk, challenging unhelpful fears and beliefs, and testing out the reality of negative thoughts.

Correct breathing techniques Something as simple as learning how to change your patterns of breathing can be of great benefit to reducing the effects of your anxiety. Hyperventilation is a key physiological problem which results in the body becoming over-saturated with oxygen and thus panic-stricken. Learning to breathe through the diaphragm instead of the chest is greatly helpful here, simply allowing the stomach to expand with each breath.

You can make sure you are breathing correctly by placing one hand on your lower abdomen and the other on your chest. correct breathing means your abdomen moves, rather than your chest. it also helps to slow your breathing while feeling anxious. you can also try to hold your breath for a few seconds. This helps to boost carbon dioxide levels in the blood and counteracts the effects of hyperventilation.

Behavior therapy A major component of behavior therapy is exposure. Exposure here simply means, removing all obstacles which are standing between you and your fear and confronting it at its most basic level. This may help to re-assess and redefine fears which might then cause a breakthrough. The steps of exposure therapy may include:

* Rank your fears in order, from most to least threatening.

* Decide to start on one of your least threatening fears.

* Perform an imaginary role-play of confronting the fears and analyze what it is exactly that is causing fear.

* Slowly increase your tolerance to confronting your fear by taking small steps towards being more and more afraid or uncomfortable.

* Resist the urge to leave. Use relaxation, breathing techniques and coping statements to manage your anxiety.

* Reflect on your result from the situation and realize that nothing bad happened.

* Repeat the exposure as often as you can to build confidence that you can cope.

* Perform the same cycle of exposure with other fears when you are ready.

Dietary adjustments changes made to regular dietary consumption can also make a big difference to the severity of your anxiety problems. Reducing the intake of caffeine is one of the most basic starting points, remembering that caffeine can be found in moderate to high doses in coffee, tea, chocolate, green tea and energy drinks. Taking more health-promoting, calming substitutes for these foods can make a huge difference in itself. Other things you can do are simple things such as eating more fruits and vegetables and eating foods which have not been highly processed. try to avoid white breads, margarine, deep fried foods and chocolate bars.

Exercise Exercise helps to promote the production of happy-hormone endorphins which make you feel good. on top of this, exercise will help to destroy stress hormones which are responsible for the “fight-or-flight” reactions our bodies have to stressful situations (also a key cause of anxiety). Aim to do a varied exercise program each week at least 3 days per week and keep it up!

Learn to be more assertive Letting people know how you feel about certain things may help to avoid loads of unnecessary stress which would otherwise be placed on you! you need to become more assertive in your communication with other people which means communicating your opinions, needs and wants more directly. This will help to build your own self esteem and also just avoids lowering your self esteem by not speaking up!

Building self-esteem Creating an environment of people and things that make you feel good about yourself will help to build your self-worth and feelings of confidence will arise as a result. With anxiety, many people typically find that low self esteem is inherent. This low self esteem can then create a compounding effect which can enhance feelings such as:

* Difficulties in functioning at school, work or in social situations.

Structured problem solving Learning how to actively seek out solutions to your problems really can be half the battle in dealing with your anxiety. many people who suffer from anxiety remain so passive and un-motivated to solve their problems that they become drowned in worry and do nothing about their problems.

Medication Drugs have been shown to be effective in treating anxiety while they are being taken. it is vitally important, however, to view medications as a short-term solution to the problem only. it has been clearly proven in medical publications that behavior therapies and regular counseling sessions when coupled with natural anxiety treatments are far more effective in defeating anxiety in a long-term way.

Where to get help

* your GP

* Local community centers and telephone lines will almost always have free services available to you should you seek them out.

Get a permanent cure to your anxiety today. Visit: [ultimate-well-being.com/health/anxiety.htm]

Author: Chris TaeniArticle Source: EzineArticles.comHow to choose a blood pressure monitor

In the case of post-traumatic stress disorder, not all symptoms are created equal.

In an effort to better treat PTSD, a study published March 1 in the journal Psychiatric Services is the first to examine which problems associated with PTSD actually correspond to lower quality of life, as indicated by the patient’s willingness to die sooner or to risk life-threatening treatment to relieve their symptoms.

PTSD is more costly than any other anxiety disorder. as many as 300,000 veterans returning from Iraq and Afghanistan currently have PTSD, with costs for their care estimated at $4 to $6.2 billion over the next two years.

“To our knowledge, this is the first study to ask actual patients with PTSD about their health preferences,” said lead author Jason Doctor, associate professor of Pharmaceutical Economics and Policy at the USC School of Pharmacy. “These findings identify targets for treatment that may improve quality of life among people with PTSD.”

The researchers found that, of four major symptoms associated with PTSD, not all were associated with a patient’s immediate quality of life, even though those who sought treatment for PTSD expressed significant overall declines in mental health.

Distressing recollections of a traumatic event and avoidance of certain activities and thoughts – both commonly conceived of as dysfunctional behaviors – had little correlation to a patient’s reported sense of well-being, according to the study.

However, symptoms tied to heightened arousal – such as trouble sleeping, irritability and vigilance – were associated with lower quality of life among PTSD patients. Anxiety and depression were also associated with lower quality of life.

“We conjecture that although avoidance is an important aspect of PTSD, its effect on quality of life may be limited because it is a coping strategy. Avoidance may be a dysfunction that improves, in the short term, subjective well-being,” explained Doctor, who is on the research faculty of the Schaeffer Center for Health Policy and Economics at USC.

The researchers found that, on average, a patient with PTSD was willing to give up 13.6 years of his or her life to live unburdened by the symptoms of the disorder.

On average, those with PTSD were willing to accept a treatment with up to a 13 percent chance of immediate death in order to achieve total relief of PTSD symptoms.

Lori Zoellner of the University of Washington, Seattle, and Norah Feeny of Case Western Reserve University were co-authors of the study.

The researchers interviewed 184 persons seeking treatment for PTSD at two treatment sites in different regions of the United States. the research was funded by the National Institute of Mental Health.

more information: Doctor et. al, “Predictors of Health-Related Quality-of-Life Utilities Among Persons With Posttraumatic Stress Disorder.” Psychiatric Services: March 2011.

Provided by University of Southern California (news : web)

ATLANTA, Feb. 24 (UPI) — Blood levels of a stress hormone are strongly linked to post-traumatic stress disorder in women, a team of U.S. researchers found.

A team of researchers from the Emory University School of Medicine and the University of Vermont said the findings are promising for developing blood and genetic tests to help predict whether a patient is going to be susceptible to PTSD.

The hormone — PACAP for pituitary adenylate cyclase-activating polypeptide — modulates central nervous system activity, metabolism, blood pressure, pain sensitivity and immune function, but it is not well understood, the researchers said.

The study, published in the journal Nature, says women who have high blood levels of PACAP display more of the symptoms of PTSD, such as difficulty discriminating between fear and safety signals and being easier to startle.

“Few biological markers have been available for PTSD or for psychiatric diseases in general,” first author Kerry Ressler of the Emory University School of Medicine said in a statement.

“These results give us a new window into the biology of PTSD. What this says is that men and women who have been traumatized may arrive at PTSD by different biological pathways.”

WEDNESDAY, Feb. 23 — Women, but not men, with post-traumatic stress disorder have high blood levels of a stress-related hormone, new research shows.

The hormone — pituitary adenylate cyclase-activating polypeptide (PACAP) — is known to affect central nervous system activity, metabolism, blood pressure, pain sensitivity and immune function.

In the new study, published in the Feb. 24 issue of Nature, researchers assessed 64 people with post-traumatic stress disorder (PTSD) and found that symptom scores were five times higher among women with above-average PACAP levels than among women with below-average PACAP levels.

The team also found that, due to genetic variations, PTSD may be triggered by different biological pathways in women and men.

The finding that PACAP levels are an indicator of PTSD symptoms may lead to new ways to diagnose and treat PTSD and other anxiety disorders, the study authors noted.

“Few biological markers have been available for PTSD or for psychiatric diseases in general. These results give us a new window into the biology of PTSD,” first author Dr. Kerry Ressler, an associate professor of psychiatry and behavioral sciences at Emory University School of Medicine, said in a university news release.

More information

The U.S. National Institute of Mental Health has more about PTSD.

Posted: February 2011

Is it anxiety or something else?

What should we be looking for when we think we may be feelinganxious or under stress? How many of you remember feeling nervousbefore a test in school? How often did you get that sick sensationas the door opened to your job interview? what happens when youfeel you might have “lost it” under what seemed to be normalcircumstances? How do we distinguish generalized anxiety from otherdisorders such as panic attacks, social anxiety disorder orpost-traumatic stress disorder? Let’s take a quick look at thedifferences.

Anxiety, as Dr. Sigmund Freud, might have viewed it in Austria morethan 100 years ago, included clinical presentations of generalirritability, anxiety attacks, apprehension/anxious expectationsand sometimes phobic avoidance.

General anxiety, today, is described frequently as excessive worry,irritability, restlessness, inability to relax, nervousness,expecting bad things to happen or perceiving bad things are aboutto happen, and the physical manifestation of agitation. Sometimesthese symptoms can lead to feelings of dizziness, free floating,increased perspiration, increased sensitivity to pain, higherstress levels and avoidance type behaviors.

Anxiety is a set of symptoms that can often form a condition, leadto the development of mood disorders such as depression or isconcurrent with other medical conditions. Anxiety was initiallythought of as learned. However, research illustrates that it’s moreoften inherited.

The following are guidelines from the “Diagnostic and StatisticalManual of Mental Disorders-IV-TR” to help you make the distinctionbetween a few of the more recognized types of anxiety conditions,as well as to help you navigate the medical landscape:

• Generalized anxiety is excessive anxiety and worry. the personfinds it difficult to control their worry. This type of anxiety canbe associated with restlessness or feeling keyed up or on edge,being easily fatigued, difficulty concentrating or your mind goingblank and irritability.

• Panic attacks are a discrete period of intense fear ordiscomfort. Symptoms might include palpitations, pounding heart,sweating, trembling or shaking, sensations of shortness of breath,feelings of choking, chest pain, nausea or abdominal stress,feeling dizzy, unsteady, lightheaded, feelings of unreality, fearof losing control or going crazy, fear of dying, numbness ortingling sensations, and chills or hot flashes.

• Social anxiety disorder is avoidance and fear of one or moresocial or performance situations, generally in a publicsetting.

• Post-traumatic stress disorder is a more distant event that is aresult of a person witnessing or experiencing an imminent threat ofdeath or serious injury of self and others. the response of theperson at that moment involved intense fear, helplessness orhorror. as a result, the traumatic occurrence is persistentlyre-experienced.

If you have any or all of the above symptoms and feel you are in aphysical emergency situation, it is better to rule out a physicalcrisis and head to the emergency room. If it isn’t a medicalemergency, check with your mental health care provider to find outmore about treating your specific anxiety symptoms.

For example, most of us remember having experienced those butterflyfeelings as a child before performing in a school play. there is noshame in seeking help for a better quality of life for thosepersistent butterflies.

Phillip Holman is the medical director of psychiatricservices at Community Physician Group at Community MedicalCenter.

WEDNESDAY, Dec. 1 (HealthDay News) — Crohn's disease may cause post-traumatic stress disorder (PTSD), a new study contends.

The study included nearly 600 Swiss adults with Crohn's disease, an incurable inflammatory bowel disorder that causes severe pain and diarrhea.

The study participants underwent PTSD assessment at the start of the study and 19 percent of them were found to have the disorder. all the participants were monitored for 18 months. The researchers found that Crohn's patients with PTSD were more than 13 times likelier to experience worsening symptoms than those without PTSD.

The study appears Dec. 2 in the online edition of Frontline Gastroenterology.

Crohn's can't be cured but PTSD can, and doctors treating Crohn's patients need to be alert for PTSD and refer patients for appropriate therapy, said the researchers, led by Roland von Kaenel, a professor with Bern University Hospital, in Switzerland.

PTSD is typically triggered by violence, natural disasters and emergency situations. but a growing body of research shows that serious illness, along with diagnostic and treatment procedures, may trigger the psychological condition.

Over a long period of time, PTSD can permanently change the body's hormonal and immune responses, making a person more prone to serious health problems, the researchers said.

"in most cases, patients avoid talking about cures which remind them of having the disease," the researchers wrote in a news release from the journal's publisher. "Such behavior may unwillingly be encouraged by the usual shortness of consultation time and unfamiliarity of [gut specialists] in dealing with the psychological needs of their patients."

More information

The Crohn's and Colitis Foundation of America has more about Crohn's disease.

In recent years, we've been bombarded with studies about the hormone oxytocin – researchers have demonstrated it increases trust and helps aid in social bonding. It has even garnered a reputation as the "love hormone." But what good is it for? Despite all these findings, the hormone's medical use remains limited to obstetrics – it is used to induce labor and aid in breastfeeding.

But researchers are now trying to apply these findings, and are investigating oxytocin as a treatment for psychiatric illnesses. they say its unique ability to adjust our wiring could remedy symptoms of schizophrenia, post-traumatic stress disorder (PTSD) and anxiety, and improve social abilities among those with autism.

A number of oxytocin studies have even reached the stage of clinical trials – which test the effectiveness and safety of a substance before it can become an approved drug – with promising findings.

"the idea of augmenting … the way we connect to and with each other, would just be so helpful for so many people," said Dr. Kai MacDonald, an adjunct professor of psychiatry at the University of California, San Diego, who has studied oxytocin as a treatment for schizophrenia.

However, the results so far, while hopeful, have not been "earthshaking," MacDonald said.

There are hurdles to such research. because oxytocin is a large molecule, it doesn't cross from the bloodstream into the brain very easily. It is also rapidly degraded in both the stomach and the blood.

Also, researchers don't know how big doses need to be, or how frequently it should be given to have a meaningful impact, MacDonald told MyHealthNewsDaily. Figuring out such dosing can be difficult.

Still, "if we could do it with any degree of precision, that would be a lovely therapeutic venue," MacDonald said.

Oxytocin is a hormone released by the pituitary gland that affects both the body and the brain. in the human body, it facilitates contractions of the uterus during labor and helps release milk during breastfeeding.

The hormone affects social interactions in a number of mammals, from mice and moles to dogs and monkeys, MacDonald said. for example, studies have shown that mice given oxytocin will huddle together, and monkeys given the hormone will spend longer grooming each other.

A barrage of studies over the last decade has indicated it has social effects on people as well.

One study found a nasal spray of oxytocin – a frequently used way to deliver the hormone, because it provides a direct route to the brain – made people more trusting. Participants were more willing to hand over money in an experimental game than those not given the spray.

Other researchers gave men oxytocin and found they more frequently looked to the eye region when shown pictures of human faces. People look to the eyes to read another's emotional state and trustworthiness, MacDonald said. [Related: 11 Interesting Effects of Oxytocin]

It's not clear that people who take oxytocin feel any different, MacDonald said. It may be that it acts subtly to change behavior or how we process social information, he said.

Though you can buy the hormone on websites that sell what they claim is an oxytocin nasal spray, whether it actually works is a different story. the claims need scientific scrutiny, a process still in its infancy, MacDonald said.

Oxytocin has not been approved to treat any psychiatric disorder, but evidence that it may be effective is building.

A small study published Oct. 1 in the journal Biological Psychiatry found that patients with schizophrenia who took oxytocin for three weeks along with their regular antipsychotic medication improved in their symptoms and hallucinated less than those who took a placebo with their antipsychotic.

While there were only 15 patients and the findings are preliminary, the results suggest oxytocin could treat patients with schizophrenia whose symptoms are not fully alleviated by their antipsychotics, said study researcher David Feifel, also of UCSD.

"the field of treating schizophrenia is kind of at an impasse," Feifel told MyHealthNewsDaily. "all our drugs that we have to date work through the same mechanisms as they did when antipsychotic drugs were first discovered 50 years ago," he said. "we are in desperate need of novel mechanisms that will improve symptoms through a different pathway, and oxytocin clearly is a novel mechanism."

Considering oxytocin's social effects, it makes sense to hypothesize it could treat autism, a condition characterized by having trouble interacting with others. And researchers have shown people with autism naturally have lower levels of oxytocin than those without autism.

A study published in 2007 in Biological Psychiatry found people with autism given oxytocin were able to determine the emotional tone of speech more consistently than those given a placebo.

Studies on other disorders have shown more mixed results. A paper published last year in the journal Psychoneuroendocrinology involving patients with social anxiety disorder found that oxytocin improved participants' self-image when they gave a speech. however, after five weeks of treatment, which also included teaching the patients to confront their social fears, those given oxytocin did no better than patients given the placebo.

Oxytocin is also being tested in clinical trials as a treatment for depression, borderline personality disorder and alcohol withdrawal.

How does oxytocin work?

One hypothesis is that oxytocin dampens the activity of the brain's fear center, the amygdala, thereby easing stress and anxiety.

A decline in anxiety could "allow people to attend to the social cues maybe they normally would avoid," said Jennifer Bartz, a professor of psychiatry at Mount Sinai School of Medicine in New York, who is conducting a clinical trial testing oxytocin as a therapy for autism. There is evidence people with autism experience anxiety in social situations, she said.

Because of oxytocin's proposed blunting effects on the amygdala's activity, scientists have also hypothesized it would help those with PTSD, which is a disorder of fear, said Miranda Olff, head of the Center for Psychological Trauma at the University of Amsterdam in the Netherlands. in PTSD, the brain "still gives the fear response as if people are back in that situation again," she said.

Olff is testing oxytocin's use in patients with PTSD in addition to standard therapies.

"Adding another biological component to this intervention might speed up recovery, or might increase the number of patients that respond to treatment at all," Olff said.

And oxytocin's trust effect could help those with schizophrenia, making them less paranoid, Feifel said.

Scientists don't know how much oxytocin goes into the brain when it is administered as a spray, or whether it even gets there, Feifel said. There is no way to see the hormone in the brain. But the effects it produces – such as a reduction in hallucinations – would require brain changes, so researchers have reason to believe it reaches the brain, he said.

It's also possible that an oxytocin dose simply triggers the brain to make more of it, MacDonald said.

Future research

While oxytocin's effects so far have been subtle rather than drastic, it could still become an important therapy. MacDonald said that most studies have looked at effects on patients after only a single dose. If Prozac, the widely-prescribed antidepressant, were administered that way, its effects would seem more subtle as well, he said.

The side effects of oxytocin have so far been benign, MacDonald said. But while it's something the body produces naturally, researchers don't know whether upping the body's natural amount, or giving it over long periods of time, could ultimately be harmful.

It also remains to be seen whether oxytocin affects men and women differently. It may present health risks to women because of its role in birth – inducing contractions of the uterus. Most studies to date have been conducted in men.

Besides mental disorders, researchers are investigating oxytocin's potential benefit for a number of other ailments, including headaches, constipation and skin damage.

For those who think they might benefit from an oxytocin boost, MacDonald noted that you don't need a spray to prompt the hormone's production."Given that some of the things that are suspected of triggering oxytocin – massage, sex, touch, eye contact – given that those are uniformly likable, it's hard not to recommend them," he said.

• 11 Interesting Effects of Oxytocin
• Mental Disorders Strike 1 in 5 Adults, Survey Finds
• Love Hormone could help Shy People Blossom

Follow MyHealthNewsDaily staff writer Rachael Rettner on Twitter @Rachael_MHND.

• Original story: Could 'love Hormone' Oxytocin Cure our Ills?

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WASHINGTON–(BUSINESS WIRE)–Smoking cessation treatment that is made part of mental health care for Veterans with Post Traumatic Stress Disorder (PTSD) improves quit rates, according to a Department of Veterans Affairs (VA) study published in the Dec. 8 Journal of the American Medical Association.

“these study findings will help us empower more Veterans with the resources they need to quit smoking. Single-shot, brief episodic care for nicotine addiction is no match for what is a chronic, relapsing disorder for many of our Veterans.”

“The smoking cessation techniques used in this new approach will give Veterans an important step towards a better quality of life,” said VA under Secretary for Health Dr. Robert Petzel. “Veterans will be at a lower risk for cardiovascular or lung disease if they do not smoke.”

on measures of smoking abstinence for shorter periods of time, researchers found that quit rates were as high as 18 percent for the integrated care group, versus 11 percent for those receiving usual care. When compared to usual care—referral to a standard smoking cessation clinic—the new, integrated approach nearly doubled the rate at which study volunteers stayed smoke-free for a year or longer, from 4.5 percent to almost 9 percent.

Importantly, Veterans in the study who quit smoking showed no worsening of symptoms of PTSD or depression. In fact, study participants averaged a 10-percent reduction in PTSD symptoms, regardless of which treatment they received or whether they quit smoking or not. The findings help dispel concerns that combining care for PTSD and smoking cessation detracts from PTSD treatment or makes it less effective.

Study leaders Miles McFall, Ph.D., and Andrew Saxon, M.D., say the results validate a promising new VA model of care that can make safe, effective smoking cessation treatment accessible to far more Veterans with PTSD. The new approach may also be effective for smokers receiving mental health care for other psychiatric illnesses, they add.

Says McFall, “One of the most important things mental health providers can do to improve the quality and length of their patients’ lives is to help them stop smoking by using proven, evidence-based practices.”

McFall is director of PTSD Programs and Saxon is director of the Addictions Treatment Center at the VA Puget Sound Health Care system. both are professors in the department of psychiatry and behavioral sciences at the University of Washington.

VA smoking cessation care generally involves a mix of group and individual counseling, typically in combination with nicotine replacement therapy or other medication prescribed by a VA health care provider. In VA’s study, Veterans in the integrated-care group worked with the same therapist on PTSD and smoking issues. Medication for smoking cessation, if used, was prescribed on an individual basis by the same medical provider managing pharmacologic treatment of the Veteran’s PTSD symptoms.

The study followed 943 Veterans at 10 VA medical centers nationwide. Prolonged abstinence from tobacco, as reported by participants, was confirmed using breath and urine tests to detect evidence of smoking. Using such “bio-verification” measures in combination with self-reports is considered the “gold standard” in smoking cessation research, says McFall.

Of some 400,000 Veterans being treated for PTSD in the VA health care system, roughly 30 to 50 percent are smokers, compared to a smoking rate of about 20 percent among VA enrollees and U.S. adults in general. Research shows, also, that those with PTSD smoke more heavily than smokers without PTSD and have an especially hard time quitting.

“We’ve come a long way in understanding that nicotine dependence for many Veterans with PTSD is a chronic, relapsing condition that responds best to intensive treatment extended over time,” McFall says. “These study findings will help us empower more Veterans with the resources they need to quit smoking. Single-shot, brief episodic care for nicotine addiction is no match for what is a chronic, relapsing disorder for many of our Veterans.”

Based on the findings and evidence from prior research, VA has begun piloting the integrated smoking cessation approach as a standard of practice at six VA medical centers. The researchers say they hope to see the new approach further expanded over time.

McFall notes that while most of the participants in the study were Vietnam-era Veterans, integrated smoking cessation care may be especially beneficial for younger Veterans with PTSD, such as many of those returning from Iraq or Afghanistan, who stand to benefit greatly from quitting smoking relatively early in life.

Says McFall, “Ideally, we can help Veterans quit smoking before it becomes a chronic or intractable condition and causes irreversible health problems such as cardiovascular or lung disease.”

The study was conducted by VA’s Cooperative Studies Program. For more information on CSP, visit csp.research.va.gov.