Cranial Electrotherapy Stimulation in the Treatment of Posttraumatic Stress Disorder
Download Article Poster presented at Creighton University St. Albert’s Day, Omaha, Nebraska, March 31, 2009
The incidence of psychological pathology due to military experience is increasing substantially; however, little research has explored treatment approaches other than psychosocial and pharmacological interventions. The effect of CES in a former military Service Member with a diagnosis of posttraumatic stress disorder (PTSD) was investigated using the PTSD Symptom Scale – Interview (PSS-I) and the Canadian Occupational Performance Measure (COPM). The subject is a 38-year-old male with a history of bipolar disorder currently 10 years post PTSD onset. He was a member of the United States Air Force from 1992-1997. The origin of his PTSD lies in 2 events occurring from 1987-1992 while he was a member of the local volunteer fire squad. The first event involved a man who committed suicide by setting his house on fire with gasoline. The man’s 2 year old daughter was still alive in the fire. In the second significant event the subject had to perform CPR for the first time on a long time friend who did not survive. He was not receiving pharmacological or traditional psychotherapy intervention although he was regularly attending support group meetings at a local VFW.
He used the CES device in his home for 20-60 minutes a day, 3 to 5 days a week for 4 weeks, set at a current level of 2.5 (250 µA) 28 of 29 days and reported positive results throughout the treatment period. The most commonly reported symptom warranting CES was irritability reported on 14 of 29 days, followed by stress and concentration. Following treatment, the subject explained that “days of irritability are more manageable; it used to be a 4-5 day event and now is only 2-3 days.” He stated that his emotions are now more “balanced and realistic” as compared to experiencing emotions at the extremes (i.e., intense anger) prior to using CES.
Post session findings revealed an increase in self-perceived efficacy of occupational performance and a decrease in intensity and frequency of PTSD symptoms. His composite PSS-I score was decreased by more than 60%, while his self-perceived efficacy in occupational performance also increased substantially. These results indicate the potential positive effects of CES therapy on intrusive PTSD symptoms, thus improving performance and satisfaction with daily activities which may further enhance the individual’s overall quality of life.
The PSS-I is a 17-item semi-structured interview that assesses the presence and severity of PTSD symptoms. The PSSI scores range from 0 (no signs/symptoms of PTSD) to 51 (experiencing all symptoms 5 or more times a week/very much). PTSD diagnosis is determined by counting the number of symptoms with a rating of 1 or greater per symptom cluster – Re-experiencing: 1, Avoidance: 3, and Arousal: 2, are needed to meet diagnostic criteria. PSS-I pre- to post-treatment scores (range 0 – 51) dropped from 34 to 13, Re-experiencing (0 – 15) dropped from 7 to 2, Avoidance (0 – 21) from 15 to 7, and Increased Arousal (0 – 15) from 12 to 4.
The COPM is a standardized measurement tool intended to measure self-perceived efficacy by facilitating participant rating of the following areas: ability to perform the identified occupations in the areas of self care, productivity, and leisure; the personal importance of the occupations; and satisfaction with current performance. The COPM uses a rating scale of 1-10 where 1 = significant impairment in ability to perform the activity, the activity has no importance to participant, and he or she is not very satisfied with his or her performance; and 10 = no impairment, the activity is very important to the individual, and he or she is very satisfied with his or her performance. COPM pre- to post test change on the 10 point scale was + 5.4 for Performance and + 7.6 for Satisfaction. and the monthly average in the Daily Symptom Log (10 point scale) was reduced from 4.1 (Range: 1 – 8) to 0.25 (Range: 0 – 2).
The researchers concluded that since 15 – 17% of soldiers returning from war in Iraq in 2004 experienced PTSD, and that this diagnosis may lead to significant disability or impairment in occupational functioning occupational therapy must prepare for the challenges presented by these recent wars and assist in minimizing the negative effects on both military personnel and society by providing an effective PTSD intervention as an adjunct or alternative to conventional psychological and/or pharmaceutical treatments.
The findings of this study have implications as the current wars in both Afghanistan and Iraq continue the personal and social cost of PTSD on returning veterans and their families will escalate. If future research findings demonstrate the effectiveness of this modality on improving the occupational functioning in clients with PTSD, it may be necessary to include this modality into occupational therapy’s scope of practice and in the professional educational training of physical agent modalities for practitioners and students.
Cranial Electrotherapy Stimulation
in the Treatment of Posttraumatic Stress Disorder
| Test | Pre-Treatment Score | Post-Treatment Score |
| PSS-I (Range: 0 – 51) | 34 | 13 |
| *Re-experiencing (0 – 15) | 7 | 2 |
| *Avoidance (0 – 21) | 15 | 7 |
| *Increased Arousal (0 – 15) | 12 | 4 |
| COPM | ||
| Overall Performance/ Satisfaction (10 point scale) | 4.6; 2.4 | 9; 10 |
| *Finances/Community Management | 4; 1 | 10; 10 |
| *Shopping/Socialization | 6; 1 | 8; 10 |
| *Work | 3; 1 | 10; 10 |
| *Reading | 2; 1 | 8; 10 |
| *Volunteering | 8; 8 | N/A |
| COPM Pre-Post Test Change | ||
| *Performance | N/A | + 5.4 |
| *Satisfaction | N/A | + 7.6 |
| Daily Symptom Log(10 point scale) | Pre-treatment session symptom severity | Post-treatment session symptom severity |
| Week 1 | 4.4 (Range: 3 – 8) | 0.43 (Range: 0-2) |
| Week 2 | 3 (Range: 1 – 5) | 0 |
| Week 3 | 4.2 (Range: 2 – 6) | 0.29 (Range: 0-1) |
| Week 4 | 4.9 (Range: 3 – 7 | 0.29 (Range: 0-2) |
| Monthly Average | 4.1 (Range: 1 – 8) | 0.25 (Range: 0-2) |
