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THE DPA AND HEART RATE VARIABILITY POST TRAUMATIC STRESS SYNDROME Pentagon report released in June 2007 reported that U.S. troops returning from combat in Iraq and Afghanistan suffered "daunting and growing" psychological problems: 38% of Army soldiers, 31% of Marines and 49% of National Guard members reported post-traumatic stress disorder (PTSD) symptoms, depression, anxiety and other potentially disabling mental disorders. Report of the Department of Defense Task Force on Mental Health — June 2007 Although not all returning soldiers develop PTSD or other mental disorders, most have significant issues returning to normal lives. Everyone has different issues while reintegrating, but common challenges include disassociation, anger, anxiety, sleeplessness, depression, nightmares, inability to stop repeating thought loops and continually replaying traumatic scenarios. Physiological responses include nausea, diarrhea and chronic pain. Many turn to drugs and alcohol to help them cope, which can lead to addiction or cause serious disruption with family members and self-destructive behavior patterns. “There is a major health crisis facing those men and women who have served our nation in Iraq and Afghanistan,” said Terri Tanielian, the project’s co-leader and a researcher at RAND, a nonprofit research organization. “Unless they receive appropriate and effective care for these mental health conditions, there will be long-term consequences for them and for the nation. Unfortunately, we found there are many barriers preventing them from getting the high-quality treatment they need.” Researchers also found an urgent need to train more mental health providers throughout the U.S. health care system on delivering evidence-based treatments to service members and veterans. While many opportunities for treatment exist for active-duty personnel, there is no system in place to monitor the quality of those services to ensure they are getting the latest science-based forms of treatment. Heart Rate Variability (HRV) has been shown to be a reliable noninvasive test for quantitative assessment of the cardiovascular autonomic regulatory responses, providing a window reflecting the interaction of sympathetic and parasympathetic tone. Alterations in autonomic function are associated with a variety of physiologic and pathophysiologic processes and may contribute substantially to morbidity and mortality. Studies have shown that patients with post-traumatic stress disorder have significantly lower HRV compared to controls, reflecting a basal autonomic state characterized by increased sympathetic and decreased parasympathetic tone. Changes in heart rate variability associated with acute stress may represent one pathway to disturbed sleep. Stress-related changes in heart rate variability during sleep may also be important in association with chronic stressors, which are associated with significant morbidity and increased risk for mortality. Heart rate varies around a mean value, depending upon inputs from the sympathetic and parasympathetic nervous system, and this variation is referred to as heart rate variability. Cohen et al. found that patients with PTSD at rest and higher heart rates, lower HRV with lower high frequency (HF reflects the vagal activity – slows down heart rate) and higher low frequency (LF affected by both sympathetic and parasympathetic), compared to controls, pointing towards a reduced resting parasympathetic tone (brake) and increased sympathetic (fight and flight). Based on this, they suggested that PTSD is a state of chronic autonomic hyperstimulation, which prevents the autonomic system from responding to further stimuli. Low HRV is associated with adverse behaviors such as smoking, alcohol, poor diet and decreased exercise, and shows a strong linear association with various components of the metabolic syndrome, such as increased systolic blood pressure, HDL cholesterol, triglycerides, waist circumference, and fasting and two-hour postload glucose levels which are all associated with increased coronary risk factors. The Digital Pulse Analyzer (DPA) provides a quick 5 minute, noninvasive assessment of HRV and can monitor efficacy of treatment modalities, as presently no system in place to monitor the quality of those services to ensure they are getting the latest science-based forms of treatment.