Dr. Hernández leads a clinically-based program of research dedicated to the use of scientifically rigorous experimental designs to investigate the role of Complementary and Alternative Medicine (CAM) in the treatment of traumatic brain injury and stress resilience. She is currently investigating the efficacy of acupressure as an intervention for reducing the stress response in athletes off of the playing field, as well as reducing the number of injuries on the field.
This study is designed to test the psychometric properties of the Interpersonal Needs Questionnaire (INQ-12) and the Acquired Capability for Suicide Scale (ACSS) in a sample of military veterans, something which has not been done. These measures were developed to assess the constructs of Joiner’s interpersonal psychological theory of suicide. Secondary goals of the study are to determine if values mediate the relationship between reasons for living and suicide risk, and whether participants’ suicidal wish can be categorized as either escaping their problems or influencing other people.
While there is a dearth of evidence-based treatment for co-occurring PTSD and mTBI, it has been suggested that best practices entail treating presenting symptoms (hyperarousal, hypoarousal, emotional reactivity, irritability, depression, anxiety, concentration problems). Yoga may be particularly well-suited to treating returning servicemen as data suggests that core symptoms that develop with a history of trauma exposure, are physiologically based, somatically experienced and often not amenable to change through talking alone. Research suggests that that moment-to-moment awareness of present experience may decrease emotional reactivity and anxiety, and increase the capacity for self-regulation. Mindfulness skills have also been associated with: building resilience in the midst of stress; allowing one to better cope with physical discomfort; decreasing anxiety and depression; decreasing reactivity. An 8-week, 16-session, hatha yoga intervention will be conducted with Veterans to assess the acceptability and feasibility of an intervention in this population. Veterans will be screened and assessed for mental and physical health prior to enrolling in the intervention. Weekly sessions, out of session practice, and weekly assessments will track possible changes in the Veterans quality of life, mental and physical health.
The research team hypothesizes that, similar to other populations, active acupressure treatments will help promote stress resilience, improve cognition and sleep, helping to reduce suicidal ideation and ultimately suicidal behavior. In addition to these potential functional benefits in Veterans, active acupressure is an independent, portable, safe and no-cost (once learned) intervention that is non-pharmacological and therefore has no side effects. The study aims to address a need (reducing military/Veteran suicidality) that has to date gone largely unmet, a need that is also currently a Department of Defense priority.
Brenner L, Bahraini N and Hernández TD (2012). Perspectives on creating clinically relevant blast models for mild traumatic brain injury and post traumatic stress disorder symptoms. Front. Neur. 3:31.
Military personnel are returning from Iraq and Afghanistan and reporting non-specific physical (somatic), behavioral, psychological, and cognitive symptoms. Many of these symptoms are frequently associated with mild traumatic brain injury (mTBI) and/or post traumatic stress disorder (PTSD). Despite significant attention and advances in assessment and intervention for these two conditions, challenges persist. To address this, clinically relevant blast models are essential in the full characterization of this type of injury, as well as in the testing and identification of potential treatment strategies. In this publication, existing diagnostic challenges and current treatment practices for mTBI and/or PTSD will be summarized, along with suggestions regarding how what has been learned from existing models of PTSD and traditional mechanism (e.g., non-blast) TBI can be used to facilitate the development of clinically relevant blast models.
McFadden, K. L., Healy, K.M., Dettmann, M. L., Kaye, J. T., Ito, T. A., & Hernández, TD. (2011). Acupressure as a non-pharmacological intervention for traumatic brain injury (TBI). Journal of Neurotrauma, 28, 21-34.
Acupressure is a complementary and alternative medicine (CAM) treatment using fingertips to stimulate acupoints on the skin. Although suggested to improve cognitive function, acupressure has not been previously investigated with a controlled design in traumatic brain injury (TBI) survivors, who could particularly benefit from a non-pharmacological intervention for cognitive impairment. A randomized, placebo-controlled, single-blind design assessed the effects of acupressure (eight treatments over 4 weeks) on cognitive impairment and state of being following TBI, including assessment of event-related potentials (ERPs) during Stroop and auditory oddball tasks. It was hypothesized that active acupressure treatments would confer greater cognitive improvement than placebo treatments, perhaps because of enhanced relaxation response induction and resulting stress reduction. Significant treatment effects were found comparing pre- to post-treatment change between groups. During the Stroop task, the active-treatment group showed greater reduction in both P300 latency (p=0.010, partial η²=0.26) and amplitude (p=0.011, partial η²=0.26), as well as a reduced Stroop effect on accuracy (p=0.008, partial η²=0.21) than did the placebo group. Additionally, the active-treatment group improved more than did the placebo group on the digit span test (p=0.043, Cohen's d=0.68). Together, these results suggest an enhancement in working memory function associated with active treatments. Because acupressure emphasizes self-care and can be taught to novice individuals, it warrants further study as an adjunct treatment for TBI.
McFadden KL, Hernández, TD, Ito TA. Attitudes toward complementary and alternative medicine influence its use. Explore (NY). 2010 Nov-Dec;6(6):380-8.
OBJECTIVE: The aim of this study was to explore how attitudes toward complementary and alternative medicine (CAM) and conventional medicine influence CAM use in a healthy population, and how health locus of control and exercise further affect CAM use. DESIGN: A cross-sectional survey design was used. PARTICIPANTS: The sample consisted of 65 healthy graduate students. MAIN OUTCOME MEASURES: Since previous studies have focused on the attitudes of medical providers toward CAM, there are currently no standard, widely used measures of attitudes toward CAM from the perspective of the healthcare recipient. Thus, a new measure, the Complementary, Alternative, and Conventional Medicine Attitudes Scale (CACMAS) was created to address how attitudes of healthcare recipients affect CAM use. The Multidimensional Health Locus of Control Scale (MHLC) was used to investigate effects of health locus of control on CAM use, and participants reported which of 17 listed CAM treatments they had used in the past, were currently using, or would likely use in the future. Participants also reported days of exercise in the past month to explore if those engaging in healthy behaviors might report more CAM use. RESULTS: Having a philosophical congruence with CAM and agreement with holistic balance was associated with increased CAM use. Dissatisfaction with conventional medicine was also related to increased CAM use, but to a lesser extent. Those attributing health to personal behaviors (an internal health locus of control) reported more CAM use, as did those engaging in more resistance training in the previous month.
McFadden KL, Hernández, TD. Cardiovascular benefits of acupressure (Jin Shin) following stroke. Complement Ther Med. 2010 Feb;18(1):42-8. Epub 2010 Feb 6.
OBJECTIVES: Acupressure, a complementary and alternative medicine (CAM) treatment, uses fingertips, rather than needles, to stimulate acupoints on the skin and has been implicated as a successful treatment for a variety of medical disorders. However, acupressure's underlying mechanisms remain unclear. One theory is that acupoint stimulation modulates autonomic nervous system activity. Previous studies have suggested that acupressure may positively affect heart rate and blood pressure. The current study investigated the effects of a type of acupressure, Jin Shin, on cardiovascular function in stroke survivors, a population that could especially benefit from a treatment promoting cardiovascular health. The study tested the hypothesis that active acupressure treatments would reduce heart rate and blood pressure (i.e., induce a greater relaxation response) above and beyond that seen during placebo acupressure treatments. METHODS: A randomised, placebo-controlled, single-blind crossover design was utilised, in which 16 participants received 8 weeks of either active or placebo acupressure followed by washout and crossover into the opposite treatment condition. Heart rate and blood pressure measurements were taken throughout treatments. RESULTS: Active acupressure treatments were associated with a significantly greater (p=.043, eta(2)=.30) and faster (p=.002, eta(2)=.76) reduction in heart rate compared to that seen during placebo treatments. No treatment effect on blood pressure was found. CONCLUSIONS: Active acupressure reduced heart rate significantly more than did placebo acupressure during treatments. Although no treatment effect on blood pressure was found, this could be due to 67% of participants taking antihypertensive medications during the study.
Theresa D. Hernández, PhD
