A recent AP article by Sharon Cohen described posttraumatic stress as something you just have to learn to live with, because you can't recover from it. [Revolving Door of Multiple Tours Linked to PTSD] . It's a terrific article, but Cohen was misled by the mental health professionals she talked to, as well as the warriors who received less than optimal treatment.
You can recover from posttraumatic stress. Certainly, you can significantly reduce - not just manage - its symptoms. But - and here's the thing - not with traditional treatment. The problem is, a lot of my colleagues don't know this yet. So they go about it in traditional ways and pronounce the condition incurable, based on the results they get.
This is changing, but not fast enough - especially given the numbers of traumatized soldiers returning home these days. And the incidence we're seeing is just the tip of the iceberg - traumatic stress can gestate deep inside the body for a long time, rearing its nasty head years later.
This phenomenon of well-meaning but ignorant mental health professionals was even more obvious a decade ago, around Ground Zero after 9/11. (I speak of this with humility, having been an ignorant but well-meaning psychotherapist myself.) The neighborhood was overrun by eager volunteers, trying to help shell-shocked survivors and traumatized recovery workers. Not only were most not helped, but many were further agitated, distressed or angered by these incursions.
Asking numb, severely traumatized people to share their feelings or describe the horrific events that triggered their distress is what therapists typically do. Yet with this population, it yields either a blank, thousand yard stare or catalyzes a re-experiencing reaction or flashback.
It turns out that people headed for a diagnosis of posttraumatic stress can't just "talk about it"- the trauma isn't even stored in the parts of the brain where language can access it. Instead it's been cached as frozen, primitive, pre-language experience - sensation, perception, emotion, images and motor reactivity - in the survival-based structures of the brain. In fact, if survivors can talk about traumatic events with appropriate feeling and clear, sequential memory, it's a good bet they're not going to acquire PTSD anyway. For whatever reasons of luck, personal history, inborn wiring and/or rote, behavioral training, they escape the diagnosis altogether.
What does help are tools that target the affected parts of the brain. So therapists who show people how to re-regulate their own hyper-activated nervous systems get results. Once the relentless cycling of neurohormones, back and forth from extreme alarm to sedated numbness can settle down, survivors can then talk and think about their trauma in traditional ways, if they choose to. They may not, because, after acquiring these skills, they may not need or want to.
So after 9/11, we saw that massage therapists who set up tables in a nearby church did a world of good by calming the bodies of firefighters, police and construction crews. Psychiatric service dogs brought solace and comfort to distraught relatives and exhausted recovery workers, with their own kind of basic magic. And professionals who taught relaxation and deep breathing skills helped, as did those who offered calming doses of hypnosis, guided imagery and brief, targeted protocols such as Eye Movement Desensitization & Reprocessing (EMDR) and Somatic Experiencing (SE).
Here's what one psychologist, Dr. Suzanne Iasenza, who saw scores of affected people in her office at the time at John Jay College observed:
"My talk therapy training hadn't prepared me for 9/11. But my training in imagery, relaxation, EMDR, conscious breathing and hypnosis was invaluable. It gave me something to do that actually helped, and a feeling I could be resourceful and of use, where so many of my colleagues were at a loss in facing such extraordinary trauma." (Invisible Heroes, p.294)
Similarly, with our returning soldiers suffering from combat stress, we have well-meaning mental health professionals volunteering to help. And, again, an awful lot of them don't know how. But they think they do. That's why we keep hearing it's an intractable condition.
What approaches get the job done with traumatized warriors suffering from combat stress? Well, for starters, let me tell you what psychologist John Fowler is doing on the TBI, Combat Stress & Pain Management Unit at Bethesda Naval Hospital. He uses a combination of biofeedback, progressive relaxation and guided imagery. He starts with a quick, user-friendly explanation of the neurophysiology of combat stress - something he feels is essential to normalizing an otherwise crazy-feeling condition. Then he gives them simple relaxation and imagery exercises in the first session, and shows them how they can reduce their physiological stress immediately and at will - they even get to see their dramatic drops on a computer screen that's hooked up to their finger.
He ascribes his outstanding success rate to the sense of empowerment, mastery and hope these wounded warriors get from putting their biochemistry "on manual" and gaining self-control over their biochemically generated symptoms. Later, if they want, they can do more traditional therapeutic work - talk philosophy, ethics, personal history or future plans. But this is where he always starts.
Another successful, innovative approach: Scripps Center for Integrative Medicine in La Jolla, co-founded by two visionary health professionals - cardiac doc Mimi Guarneri and nurse-manager Rauni King - uses a combination of Healing Touch (a kind of super-relaxing, energy balancing and healing treatment, similar in many ways to Reiki) combined with guided imagery on post-deployed, traumatized troops. An ongoing research protocol tests for outcomes - hopefully we'll see published results next year. Again, by first settling down the agitated neurohormones of combat stress, these soldiers can experience an immediate drop in symptoms and sidestep a world of hurt. Like Fowler's Marines, these service people take to this body-based approach and ask for more, beyond the purview of the study.
Additionally, some ingenious work has been done with troops by corporate trainer and stress mitigation coach Steve Robinson and his team, who, in four hours, teach key skills, starting with explaining the neurophysiology of traumatic stress ("Your brain stem's been hijacked"). After destigmatizing the condition by casting it in somatic terms, they teach breath and heart rate regulation using a popular method from the corporate world called HeartMath, along with meditation, imagery, biofeedback and energy release work. The net effect is a non-pathologizing set of tools that mitigate combat stress before it can take on a life of its own.
And with the most cost effective intervention of all, research psychologist Jennifer Strauss at Duke and the Durham V.A. has spent the past 7 years investigating the impact of portable, self-administered guided imagery and music audio downloads on veterans with PTSD - those suffering from military sexual trauma and combat trauma, longstanding or recently acquired, from the Vietnam era to the Iraq and Afghan wars. She too is finding impressive drops in symptoms, after veterans listen to their MP3 players once a day, five times a week, for 8 weeks - even among those who've suffered for 5 decades, and who were relatively untouched by traditional combinations of psychotherapy and medication. Something in the soothing, self-regulating music, voice and images, and the weekly check-ins by a mental health professional, makes a sizable dent on the so-called intractable symptoms of PTS.
I could cite many more examples, but instead let me point to the consistent threads running through these approaches:
1. They first and foremost find ways to re-regulate the nervous system.
2. They destigmatize and normalize the experience by explaining PTS as the somatic and neurophysiologic condition it is.
3. They offer simple, self-administer-able tools that empower the end-user and confer a sense of mastery and control.
4. The interventions are cast as training in skill sets, not the healing of pathology.
So, hopefully those of my colleagues who aren't up to speed will soon be learning some new skills. And hopefully they'll stop talking to reporters and soldiers until they do. In the meantime, the general public and our military need to demand treatments like the ones cited above, and reject the idea that this condition is incurable. Thankfully we know better now.
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