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Integrative Psychiatry

Novel Approaches to Traumatic Brain Injury by Dan Engle, MD

By February 27, 2021March 6th, 2024No Comments

Watch our short video as Dr. Dan Engle shows us the pathophysiology of Traumatic Brain Injury (TBI).

FULL TRANSCRIPT

These are going to be novel approaches to TBI only because the standard care doesn’t really utilize a lot of these methodologies, even though they have really good data. Part of what happens in neurology, that can be consistent with psychiatry too, is we have excellent diagnostics and fairly lousy therapeutics.

I’ve learned from a variety of different therapeutic models and other integrative approaches, and we really take a transdisciplinary approach to TBI.

Pathophysiology of TBI

  • Sheering Forces
  • Axonal and Pituitary Injury
  • Inflammatory Cascade
  • Weakening of BBB
  • G-E-N-I-E Disruption

The pathophysiology of TBI, traumatic brain injury, what happens is you typically have this acceleration deceleration injury. The force that happens isn’t necessarily like the tofu brain bouncing around a really sharp, hard skull, as much as it is the force that includes the brain moving in a particular trajectory, and then all of a sudden stopping really fast.

PCS Symptoms = 3+ for > 3 mons. (+/- LOC)

When these symptoms, being three or more, that are necessary over a period longer than three months post injury that does not have to include loss of consciousness. That’s a really important one, these symptoms that are related to concussion for sure, but what we’re talking about here is post-concussive syndrome. These symptoms lasting for longer than three months: problems with concentration, memory (those are more cognitive performance measures), mood dysregulation, sleep challenges, chronic headaches, light noise sensitivity. This is super common. And it’s almost pathognomonic for post concussive issues.

Targeted Innervations

G-E-N-I-E

So targeted interventions we’re looking for is the Genie and what is the thing that’s sticking up so to speak, what’s the biggest barrier to entry for healing?

Most mild to moderate TBI will spontaneously heal on their own. When they don’t, there’s usually something blocking. That’s why they’re seeing you. If they were already spontaneously healed, they wouldn’t need to see you. So diagnostic testing, your basics are your routine unit basic lab panels, blood chemistry panels, hormone markers, Detoxigenomics, oxidative stress markers, quantitative EEG brain mapping, essentially be able to show how the brain is functioning.

Most vets that I speak to, athletes too, but this is constantly something that vets will say, they’d rather have their leg blown off than their head blown up, because this is an invisible illness. It’s super frustrating for people to go through this because nobody else can know what post-concussive syndrome is like, and it doesn’t look like anything from the outside because you’re not wearing a cast, you’re not on crutches, you don’t have an obvious limb malformation post injury, so it’s hard to get other people on your map.

Detoxification

O.P.E.N.

You just should know that sometimes the brain is not healing from a head trauma because it’s got toxicity. And what are those toxicities? I use the acronym O.P.E.N. Essentially, we’re trying to open up the channels for detoxification. That can really look like opportunistic infections, the big one being viruses, EBV and CMV. And it doesn’t have to be somebody who lives in a high, humid environment. Sometimes it’s a person who got traumatized when they were in a mold exposed environment, and there’s residue still there. There’s not a whole lot of mold there because it tends to be an arid, low humidity environment. But if you start unpacking the history, then it could have been somebody who got injured or exposed when they were living somewhere else.

Lifestyle Support – D.R.E.A.M.S.

And then lastly, D.R.E.A.M.S.

This is the acronym for diet, rhythm, energetics, attitude, movement, and sleep. This is everything in the umbrella of lifestyle support. I like this acronym too, because we’re trying to do two things. We’re trying to help people get into restorative sleep, which oftentimes includes more dream recall. But you also want to help people move through their challenge in order to realize their dreams. So when you can help somebody realize their dreams, you’ve just started to exponentially benefit that person’s life and then everybody they come into contact with.

Sara Reed, MS, LMFT

Sara Reed is a Licensed Marriage and Family Therapist and CEO of Mind’s iHealth Solutions, a digital health company that provides evidence based and culturally responsible mental health services for underserved groups. As a mental health futurist and clinical researcher, Sara examines the ways culture informs the way we diagnose and treat mental illness. Sara’s prior research work includes participation as a study therapist in psychedelic therapy research at Yale University and the University of Connecticut’s Health Center. Sara was the first Black therapist to provide MDMA-assisted psychotherapy in a clinical trial and continues to engage in ongoing advocacy work around health equity in psychedelic medicine.

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Jeffrey Guss, MD is a psychiatrist, psychoanalyst, and researcher with specializations in psychoanalytic therapy and the treatment of substance use disorders. He was Co-Principal Investigator and Director of Psychedelic Therapy Training for the NYU School of Medicine’s study on psychedelic-assisted psychotherapy in the treatment of cancer-related existential distress, which was published in Journal of Psychopharmacology, 2016. He currently is a study therapist in the NYU study on Psychedelic-Assisted therapy in the treatment of Alcoholism, a collaborator with Yale University’s study on psychedelic-assisted therapy for Major Depressive Disorder and a study therapist with the MAPS (Multidisciplinary Association for Psychedelic Studies) study on treatment of Post Traumatic Stress Disorder with Psychedelic-Assisted Psychotherapy. 

Dr. Guss is interested in the integration of psychedelic therapies with contemporary psychoanalytic theory and has published in Studies in Gender and Sexuality and Psychoanalysis, Culture and Society. He has published (with Elizabeth Nielson, PhD) a paper on “the influence of therapists’ first had experience with psychedelics on psychedelic-assisted psychotherapy research and therapist training” in The Journal of Psychedelic Studies, August, 2018. He is an Instructor and Mentor with the California Institute of Integral Studies’ Center for Psychedelic Therapies and Supervisor in NYU’s Fellowship in Addiction Psychiatry. 

Dr. Guss maintains a private practice in New York City.

Will Van Derveer, MD

Will Van Derveer, MD is Co-Founder of Integrative Psychiatry Institute and Integrative Psychiatry Centers. Dr. Van Derveer was co-investigator on a phase 2 MAPS study of Psychedelic-assisted psychotherapy for treatment-resistant PTSD, and co-authored the publication of this study in 2018. He has also provided Psychedelic-assisted psychotherapy in two MAPS training studies. An active provider of KAP at his clinic in Boulder, CO, he has been teaching others KAP therapy for several years. Dr. Van Derveer contributed a chapter on mescaline in the 2021 "Handbook of Medical Hallucinogens" (edited by Charles Grob and Jim Grigsby). He is co-host of the Higher Practice Podcast.

Dr. Van Derveer regards unresolved emotional trauma as the most significant under-recognized root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass.


Scott has been a student of consciousness since his honors thesis on that topic at the University of Arizona in the 1970s under the tutelage of Dr. Andrew Weil. Following medical school, Scott studied Jungian therapy and acupuncture while working as a primary care physician in a rural area for four years. Psychedelic-assisted psychotherapy became a facet of his practice before this medicine was scheduled in 1985. He then completed a psychiatry residency at Columbia program in New York. Scott studied cross-cultural psychiatry and completed a child/adolescent psychiatry fellowship at the University of New Mexico.

In 2010 he founded Wholeness Center in Fort Collins. This innovative clinic provides cross-disciplinary evaluation and care for all mental health concerns. Scott serves as a site Principal Investigator and therapist for the Phase III trial of psychedelic-assisted psychotherapy for PTSD sponsored by (MAPS). He has also published numerous articles about his research on (CBD) in mental health. Currently, Scott works extensively with psychedelic-assisted-psychotherapy. He lectures all over the world to professional groups interested in a deeper look at mental health issues, safer tools, and a paradigm-shifting perspective about transformative care.

Will Van Derveer, MD is co-founder of Integrative Psychiatry Institute (IPI), along with friend and colleague Keith Kurlander, MA. He co-created IPI as an expression of what he stands for. First, that anyone can heal, and second that we medical providers must embrace our own healing journeys in order to fully command our potency as healers.

Dr. Van Derveer spent the last 20 years innovating and testing a comprehensive approach to addressing psychiatric challenges which transcends the conventional model he learned in medical school at Vanderbilt University and residency at University of Colorado, while deeply engaging his own healing path.

He founded the Integrative Psychiatric Healing Center in in 2001 in Boulder, CO, where he currently practices. Dr. Van Derveer regards unresolved emotional trauma as the most significant root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass. In addition to his clinical work and teaching, he was co-investigator in 2016 a Phase II randomized clinical trial, sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS). He continues to support this protocol, now in a Phase III clinical trial under break-through designation by FDA.

Dr. Van Derveer is a diplomate of the American Board of Integrative and Holistic Medicine (ABoIHM) since 2013, and he was board certified in the first wave of diplomates of the new American Board of Integrative Medicine (ABIM) in 2016.