“Long haul cognitive effects of Covid-19” in those who have “recovered” Live zoom presentation by Whittier Rehabilitation Hospital – it was a lively event.

MICHAEL SEFTON

Thanks for those of you who signed on the last night’s webinar.  The Zoom presentation will be available at the Whittier Health website in the next couple weeks if interested. As we learned, even patients’ with mild infection can experience long lasting cognitive impact from the Covid-19 virus in the areas of memory, concentration, mental endurance, organization and verbal expression. There are mental health concerns as well that should not be overlooked.  Recovery from the virus can take weeks to months after the termination of treatment.  

The presentation on the impact of cognitive and behavioral functioning on ‘long haul’ cases is somewhat concerning given the 32 million Americans who have suffered with the virus. This is the second in a series produced by WRH and follows the November 2020 presentation on the psychological impact of the disease.  We will have a post here on the discussion from the webinar in the coming days.  The early studies have shown data from the population in Italy who have recovered from the virus in the first wave of the pandemic.

PTSD, biofeedback and preexposure training to lower impact of stress

PTSD is a known reaction to exposure to high stress, life threatening incidents that occur frequently in the careers of members of law enforcement. These are the high stress calls for service that leave a mark. They are the calls that wake you up at night and have the potential to become the traumatic events that can derail job performance. These are calls you think of when responding to an all units – referred to as a “code 3″ response in Maine during my tenure there. These are the calls that even when everything went well, the outcome turned out bad. And that is what is so debilitating and breeds cynicism.

Improving emotional regulation in the career first responder is a key element in officer well-being and career satisfaction. Biofeedback can be useful in shaping the body’s response to high stress calls. It involves decreasing certain brain responses to negative stimuli and is a critical skill for adaptive stress responses. Improved emotion regulation is associated with a decrease in amygdala hemodynamic activity following strongly negative stimuli providing researchers with a neural target that could be manipulated to improve emotion regulation.” Over the career of a law enforcement officer he or she can be expected to experience scores of traumatic calls sometimes more. Having a way to get out in front of the impact of such events using routine defusing or modified debriefing strategies can add to job satisfaction and officer resilience.

The cognitive model of PTSD suggests that the sense of current threat in individuals with PTSD is due to excessively negative appraisals of the trauma and a disturbance of memory of the trauma (Ehlers & Clark, 2000). Meichenbaum contends that SIT helps patients to “reauthor” their personal narrative of the trauma and focus on using coping skills to achieve treatment goals (Meichenbaum, 2019).

What is currently the best EEG intervention for mood and anxiety disorders — changing the alpha-to-theta ratio so that alpha activity is decreased relative to theta in the brain. Importantly, chronic exposure to traumatic scenes and a host of other factors can slowly elevate the sympathetic nervous system so that even routine police encounters can feel like a threat to officer safety and evoke a traumatic reaction.

A cardinal feature of patients with PTSD is sustained hyperactivity of the autonomic sympathetic branch of the autonomic nervous system, as evidenced by elevations in heart rate, blood pressure, skin conductance, and other psychophysiological measures. Accordingly, increased urinary excretion of catecholamines, and their metabolites, has been documented in combat veterans, abused women, and children with PTSD.  Sherin, 2011 Sherin, J, Newmeroff, C (2011). Post-traumatic stress disorder: the neurobiological impact of Psychological trauma. Dialogues in Clinical Neuroscience, September 13 (3)

“There is evidence that humans who are exposed to stress induces the release of dopomine in mesolimbic areas deep within the brain. The limbic system is the center for processing emotion and the minutiae of detail such as sites, smells, and the sound of raw pain and despair officers routinely encounter. These chemicals in turn could play a role in neuromodulation in the HPA axis that regulates the fight-flight mechanism in the brain. Whether or not dopamine metabolism is altered in PTSD remains conjectural, though genetic variations in the dopaminergic system have been implicated in moderating risk for PTSD” Sherin, 2011.

Particularly for stress management, targeting deeply located limbic areas involved in stress processing has paved new paths for brain-guided interventions. I have written about the neurobiology of police work in these pagesSix neurofeedback sessions resulted in significant improvements in measures of emotion regulation, including faster reaction times, in an emotion-regulation testing version of the classic Stroop paradigm. This finding indicates that participants got better at focusing on task-related information and ignoring irrelevant emotional stimuli. 

This finding indicates that participants got better at focusing on task-related information and ignoring irrelevant emotional stimuli. Furthermore, alexithymia scores (difficulties in cognitively processing emotion) were decreased relative to the participants’ score before training. Alexithymia scores increased in the control group of soldiers who did not receive any training, suggesting that the intervention prevented certain issues from developing according to Young, 2019.

What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is a form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders and severe mental illness. Numerous research studies suggest that CBT leads to significant improvement in functioning and quality of life. In many studies, CBT has been demonstrated to be as effective as, or more effective than, other forms of psychological therapy or psychiatric medications.

It is important to emphasize that advances in CBT have been made on the basis of both research and clinical practice. Indeed, CBT is an approach for which there is ample scientific evidence that the methods that have been developed actually produce change. In this manner, CBT differs from many other forms of psychological treatment. CBT is based on several core principles, including:
  1. Psychological problems are based, in part, on faulty or unhelpful ways of thinking.
  2. Psychological problems are based, in part, on learned patterns of unhelpful behavior.
  3. People suffering from psychological problems can learn better ways of coping with them, thereby relieving their symptoms and becoming more effective in their lives. Source: APA Div. 12 (Society of Clinical Psychology)

“Further, administration of the centrally acting β-adrenergic receptor antagonist propranolol shortly after exposure to psychological trauma has been reported to reduce PTSD symptom severity and reactivity to trauma cues.” Sherin, 2011 Stress inoculation is the best that first responders can hope for coupled with reliable self-care and mindfulness. _______________________________ Young, K.D. Neurofeedback for soldiers. Nat Hum Behav 3, 16–17 (2019). https://doi.org/10.1038/s41562-018-0493-2 . taken April 7, 2021

Meichenbaum, D. (2004) Stress Innoculation Training. Taylor and Francis.

Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345.

Keynan, J.N., Cohen, A., Jackont, G. et al. Electrical fingerprint of the amygdala guides neurofeedback training for stress resilience. Nat Hum Behav 3, 63–73 (2019). https://doi.org/10.1038/s41562-018-0484- 

Sherin, J, Newmeroff, C (2011). Post-traumatic stress disorder: the neurobiological impact of Psychological trauma. Dialogues in Clinical Neuroscience, September 13 (3)

Sefton, M (2019) The Neurobiology of Police Work. Linked In post May 2-2019