Good morning, everyone. It's an honour to be able to join your meeting.
I just want to give a very brief overview of post-traumatic stress disorder, and of course today the focus is on occupational stress injury. As we know, post-traumatic stress disorder can occur from a number of causes, but our first responders are very much affected by post-traumatic stress disorder. They're often exposed to horrific events, so we often have a lot of trauma-related disorders in this population. We also often hear about our war veterans who are, of course, very much affected by traumatic stress as well. As well, something we often don't like to talk about and we're afraid to talk about is childhood abuse. That can be very common and can also be an important risk factor for the later development of post-traumatic stress disorder if the child is exposed to further traumatic events in adulthood.
Just to give you an overview of PTSD symptoms—I'm sure you're familiar with them already—I think the core of post-traumatic stress really is that the traumatic memory is not remembered, but rather it's relived. So when people relive the traumatic memory, they actually feel as if they're back at the scene of the trauma. They may have visual flashes; or they may have hearing flashes of what happened at the time of the trauma, for example screeching tires or people screaming; or they may actually feel what happened at the time of the trauma. They're reliving these sensory flashes that are really relived and not remembered. They actually feel as if they're right back at the scene of the trauma.
People with PTSD also often avoid things that remind them of the trauma. For example, if they've been involved in a bad car accident, they may avoid certain roads, or avoid driving altogether. Often their emotions become so intense that they numb out, because they can't handle the intensity of the emotions anymore.
People often also have a lot of other negative emotions: a lot of anger, a lot of guilt, a lot of shame. For example, I saw an advanced care paramedic the other day who was treating a teenager who was about to die, and the teenager begged him to call his mother, but he wasn't able to, and so he was just guilt-ridden after this traumatic event.
People can also have intense hyperarousal symptoms. They feel on edge; they feel on guard all the time; and they're often very hypervigilant.
That's post-traumatic stress in a nutshell. We've read a lot about it in the media lately, and although we've done a lot about educating the public, there are still some people who think it's all in your head. Actually, as we're learning now, it's a lot in your brain.
I want to talk a little bit about some recent technologies, especially neuroimaging, that have allowed us to transform an invisible injury—which is traumatic stress—to a visible injury. Neuroimaging can look at which areas of the brain activate when people recall traumatic memories, for example. I think this is really important to reduce the stigma of traumatic stress disorders, but also of other mental illness.
I just want to give you a case example of a couple who were involved in a car accident recently. They were driving down Highway 401 from London, Ontario, to Detroit and they hit a thick wall of fog. The husband was the driver and the wife was in the passenger seat, and when they hit the wall of fog, the husband slammed on the brakes. Within seconds, a huge tractor-trailer hit the back of their car. Within minutes, this was a several-hundred-car pileup, and a van was pushed into the couple's car. The van caught fire. There was a teenager in the van, and the couple heard the teenager scream while she burned to death.
It was a horrible accident, but it allowed us to really study the different reactions people can have in response to a trauma, and how those manifest in the brain. During the accident, the husband was really anxious, hyperaroused, and he was planning how to get himself and his wife out of the car. He smashed the windshield and was able to pull his wife out. After the car accident, he suffered from PTSD, which was later treated, and he recovered.
We were able to look at what happened in his brain while he recalled the traumatic event, the car accident, a month after the accident.
This is what we saw. Just to summarize for you, we saw a lot of emotional reactivity in the brain. When he was in the scanner and was having a flashback, we saw the front part of the brain activating, which might have been involved in planning and might have been activated because he was [Technical difficulty—Editor] again planning how to get himself and his wife out of the car. The visual part of his brain activated, which may have been related to the fact that he was actually seeing the accident over and over again while he was in the brain scanner.
His wife reacted very differently. She shut down. She was numb. She was barely able to move during the accident. She froze. She said that if it hadn't been for her husband, she never would have gotten out of the car. We also scanned her, and her reaction was very different when she was in the scanner. As in the accident, she froze, numbed out, and was barely able to move. If you compare her brain image to his, it looks very different. You see a total shutdown of brain response, which may reflect the fact that she was so shut down and numbed out.
This I think helps us understand that people who have the same trauma can really respond very differently. Some people have really high emotion after a trauma, and some people numb out and have very low emotion. People with low emotion are often harder to recognize, and they're also harder to treat, because first you have to bring online their ability to feel again, and often people cycle between high and low emotion as well.
What are some of our treatment options? We've come a long way in really developing some good treatment options. There are two arms of treatment choices. There's a medication arm, and there's a talking therapy or psychotherapy arm. Both have been shown to be effective. Some people prefer one or the other and some prefer to engage in both. I think we really have to move more to an individualized medicine approach to help people pick what their preferred choice may be, of course with a recommendation from their treatment team.
On treatment targets, I think it's important to treat the PTSD symptoms but also related problems. People often also have depression when they have PTSD, or they have alcohol and drug use. Often, people get so overwhelmed with feelings that they turn to drugs or alcohol to help them decrease their intense emotional states. People also often turn towards disordered eating. Also, traumatic brain injury often can be associated with post-traumatic stress. We've heard a lot about that in the military.
I think it's also really important, of course, to treat the disability and the quality of life and really help people to experience pleasure and joy again at the end of treatment. It's really about being in the optimum zone of emotional arousal. As we saw with this couple, people can have too much or too little emotion. They can be in the upper part of this curve where they're too hyperaroused, unable to think and react rationally, and unable to stand back and reflect, or they're too low on this diagram, where they're frozen and numb and they can't engage.
If you're too high or too low, you can't engage in optimum work functioning or optimum social functioning, so it's really about getting people back into the optimum zone of emotional arousal so that they don't have too much or too little emotion and they don't circle between having too much and too little emotion.
I think that in terms of priorities we're looking at education, and I think that especially with the recent legislature this will be implemented: really educating people about the risks of their jobs, getting them to become aware of early symptoms, and then really engaging in early intervention. Also, I think we have to continue to reduce the workplace stigma. Again, I think we've come a long way, but we still have a ways to go, because we don't want people to think, for example, the way this man on the diagram does. Which was worse for Phil? Depression or having to hide it?
I think we've come a long way. There's a lot of hope. We need to empower and keep reducing the stigma of those who suffer from trauma-related disorders.