There is Hope! Treating PTSD and other unprocessed traumatic memories

FULL RECOVERY – TREATING PTSD (Chapter 9, pages 171-187)

Excerpted from Mark I. Nickerson and Joshua S. Goldstein's book "The Wounds Within: A Veteran, a PTSD therapist, and a Nation Unprepared (2015).

Trauma recovery has three phases—stabilization, trauma treatment, and integration

       1.  Stabilization – Identify the problems; reduce the most acute symptoms; build motivation and commitment to the recovery process.  The goal is for veterans to acquire enough coping strategies that facing traumatic memories won’t make matters worse.  Stabilization includes:

a.      Setting the stage for treatment success

b.      May require a secure 24-hour environment until the client feels safe enough on their own

c.      May mean addressing day-to-day struggles, such as substance abuse, life management problems, troubled relationships, finding a job, and making ends meet financially

d.      Teaching veterans how to build the capacity to observe what they are going through in a somewhat detached way so as not to be consumed or defined by their traumatic memories

e.      Helping veterans identify aspects of their healthier identities, which may also require helping them remember times in their lives that were not dominated by problems

f.       Creating a strong and secure relationship of trust between veterans and treatment providers—respecting and maintaining a veteran’s personal dignity are paramount

g.      Having a chance to tell their stories and being heard respectfully are key

h.     Crucial first steps may include helping veterans learn new techniques and strategies:

                                                    i.     Stress management

1.      Physical and mental relaxation

2.      Positive thinking

3.      Exercise

4.      Prayer

5.      Problem solving

                                                  ii.     Anger management

1.      Taking responsibility for one’s anger

2.      Identifying warning signs when triggered

3.      Developing strategies for calming down and distancing oneself from triggering situations

4.      Take action to ensure the physical and emotional safety of all involved

                                                 iii.     Making sleep the highest priority

1.      Sleeplessness exacerbates other difficulties

2.      Develop healthy routines and practice self-calming methods

3.      Avoid using alcohol and/or drugs to induce sleepiness

4.      Sleep during the day, if needed, to feel safe

                                                 iv.     Processing loss and sadness (strategies to avoid becoming overwhelmed)

1.      Take time to talk and grieve with other veterans (unprocessed grief can lead to depression)

2.      Plan symbolic activities on those dates that trigger sadness

3.      Journal good memories, regrets, current feelings, etc.

4.      Write a heartfelt letter to the deceased person and/or create a memorial or photo album to honor and document their life

5.      Share feelings of survivor guilt with others; learn to forgive oneself

6.      Mobilize energy to try things that used to be fun

         2.  Trauma Treatment – Involves directly facing and working with specific traumatic memories.  There are four recommended treatment approaches—exposure-based therapies (ET); cognitive-based therapies (CT); stress inoculation training (SIT); and eye movement desensitization and reprocessing (EMDR).  All four approaches meet the standards for evidence-based psychotherapies, meaning that the research has substantiated their effectiveness for PTSD treatment.  Each recognizes that PTSD symptoms include a mixture of cognitive, emotional, psychological, physiological, and behavioral symptoms.

a.      Exposure-based therapies (ET) – Bring up traumatic memories through imagined or acted-out scenarios, or through oral or written stories, while helping the client restructure thoughts (such as actual versus perceived danger) and learn relaxation techniques.

b.      Cognitive-based therapies (CT) – Work with clients to specifically change the thoughts and beliefs connected to the traumatic event; also often includes relaxation techniques and a general discussion of the event.

c.      Stress inoculation training (SIT) – Teaches methods of breathing and muscle relaxation and includes cognitive elements—i.e. self-dialogue, thought-stopping, role-playing—and exposure techniques.

d.      Eye movement desensitization and reprocessing (EMDR) – Uses alternating eye movements combined with an exposure component (recalling the traumatic event), a cognitive component (reassessing thoughts and beliefs), and a self-monitoring of emotion and body reactions component.

 3.   Integration – EMDR is aimed at repairing the indirect effects of PTSD, including the impact on relationships, health, opportunities in the world, self-regard, and blocks to personal fulfillment; working through grief is an important component of integration work.  As clients experience relief from their symptoms through EMDR therapy, they develop a more positive outlook, are able to move forward with their lives, and view their past differently.  Veterans are able to take satisfaction from the positive aspects of their war experiences.  Integration is about making sure the improvements last, which includes regaining vitality, breaking bad habits, and designing the next stage of life.

Note: What exactly is EMDR and how it works will be explained in next week's blog post.