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Welcome to CombatCounselor Chronicle, an E-zine dedicated to giving you the most current, pertinent information on cognitive behavioral therapy (CBT) and mindfulness-based CBT available.

Chris Sorrentino, a.k.a CombatCounselor, is a leader and expert in cognitive behavioral therapy. He combines 30 years of experience in psychology with the discipline from having served as a U.S. Air Force officer for 20 years, 4 of those in combat zones, retiring as a lieutenant colonel in 2005.

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Monday, March 31, 2014

Is a Smaller Amygdala The Cause Or An Effect of PTSD?

PTSD Linked to Smaller Brain Area That Helps Regulate Fear

In an recent article by Janice Wood, researchers at Duke University and the Durham VA Medical Center discovered that combat veterans with post traumatic stress disorder (PTSD) are more likel to have a significantly smaller amygdala than those without PTSD. The amygdala is a small structure in the brain which regulates emotions, in this case fear and anxiety, with anxiety literally being  "the fear of fear".

Wood states that "their study provides evidence that smaller amygdala volume is associated with PTSD, regardless of the severity of trauma. But, they add, it’s not clear whether the physiological difference was caused by a traumatic event, or whether PTSD develops more readily in people who naturally have smaller amygdalas."

“Researchers found 20 years ago that there were changes in volume of the hippocampus associated with PTSD, but the amygdala is more relevant to the disorder,” said Rajendra A. Morey, M.D., M.S., assistant professor at Duke and lead author of the study.

Morey noted that studies in animals have established the amygdala’s role in regulating fear, anxiety and stress responses, but its effect on human behavior is less well known. “It’s associated with how fear is processed, especially abnormal fear processing,” he said. “So it makes sense to look at the structure of the amygdala.”

The researchers recruited 200 combat veterans who served in Iraq and Afghanistan after Sept. 11, 2001; half had PTSD and the other half had been exposed to trauma, but did not developed PTSD. Amygdala and hippocampus volumes were computed from MRI scans of all 200.

The researchers found significant evidence that PTSD was associated with smaller volume in both the left and right amygdala, and confirmed previous studies linking the disorder to a smaller left hippocampus. The researchers emphasize that the differences in brain volumes were not due to the extent of depression, substance abuse, trauma load or PTSD severity, factors they took into account in their statistical model.

PTSD strikes nearly 14 percent of combat veterans serving in Iraq and Afghanistan, according to the Department of Veterans Affairs. PTSD also is estimated to affect 6.8 percent of adults in the general population who have suffered abuse, crimes and other traumas.
“The next step is to try to figure out whether a smaller amygdala is the consequence of a trauma, or a vulnerability that makes people get PTSD,” Morey said.
He said the study showed that amygdala volume does not appear to be affected by the severity, frequency or duration of trauma, indicating that these factors do not cause the amygdala to shrink. It appears more likely, according to the researchers, that people with measurably smaller amygdala to begin with are susceptible to PTSD, but more studies are needed to make that determination.

Morey said he and colleagues are exploring that question, and are intrigued by evidence from their study that suggests people may have a propensity for developing PTSD based on inherently smaller amygdala volume.
“This is one piece in a bigger puzzle to understanding why some people develop PTSD and others do not,” Morey said. “We are getting closer to that answer.”
Funding for the study, which was published in the journal Archives of General Psychiatry, came from the U.S. Department of Veterans Affairs and the National Institutes of Health.

Friday, March 21, 2014


According to an article in your March 24, 2014 issue, George W, Bush and Army General Chiarelli, well respected  psychologists and scientists?, believe and profess that removing the word "disorder" from post-traumatic stress disorder (PTSD) is going to single-handedly end the military and veteran mental health and PTSD stigmas. Sorry boys, don't be ignorant ... ain't gonna happen!

President Bush's endorsement of this half-baked idea is as sound as my abilities in brain surgery and General Chiarelli's influence and support would be better utilized by focusing on the real causes of the stigmas, lack of confidentiality in military mental health, the macho bravado and ignorance endemic in the military, and the inaccurate portrayal of veterans and military members in the media.

PTS Without "Disorder" WILL NOT END THESE STIGMAS gentlemen. Use your clout to attack their real causes before more American heroes decide suicide is a better alternative than seeking treatment, risking security clearance and career, or being called a wimp. 

As a licensed professional counselor with 23+ years of experience treating military and veterans with anxiety (including PTSD) and depression, a retired military officer, and disabled veteran, I have written and advocated extensively on this topic. Specifically, my article THE STIGMAS KILLING AMERICAN HEROES. and two White House Petitions asking President Obama to address the stigmas, which garnered a whopping 70 signatures each out of the tens of thousands who heard my pleas, outlined clear, tangible courses of action. I have also written to Air Force Times on numerous occasions regarding this exact topic, but was ignored. But who can blame you when you have such authoritative experts in psychology and military/veteran mental health as President Bush and General Chiarelli?

C.T. Sorrentino, LtCol, USAF (Ret)
aka CombatCounselor
Lawrence, KS

Sunday, March 2, 2014

Psychology Today's "Dear Abby" Unethical in Advice to Reader

Letter to the Editor: T

In regard to her column in the April 2014 issue of Psychology Today, Hara Estroff Marano was out-of-line. The reader asked for help in getting "the spark" back in her relationship with a man she obviously loves. Ms. Marano was not only incompetent and unprofessional in her response, she was unethical. I'm not sure what her qualifications are, but based on previous columns and this, she apparently does not answer to a code of ethics.

Her judgmental "advice", something a licensed clinician who adheres to a code of ethics would never offer, was appalling. Take a six-month break, date other people, better qualities? This poor woman has the values and motivation most people should emulate, loyalty and respect toward the man she loves, and all the "fraud" you apparently allow to dole out advice in your magazine can do is recommend bailing on the relationship? 

Ms. Marano obviously does not know any better, but you as editor of such a popular and influential national publication should know better than to allow this type of garbage to be published. Shame on you.

C.T. Sorrentino, LtCol, USAF (Ret)


aka CombatCounselor