Last year I watched a 60 Minutes segment on the treatment of vets with PTSD which I found disturbing. In light of the reality that vets are dramatically underserved for mental health problems as it is, the method depicted on the program to relieve them of their combat-related pain only seemed to complicate their problems.
The episode showed vets being treated in a group setting with a method that used to be referred to as implosion or immersion therapy. The theory behind it is that reliving a traumatic experience repeatedly will eventually desensitize combat veterans to the degree that they can eventually tolerate the formerly intolerable symptoms.
The medical analogy would be the gradual inoculation of the body with antibiotics or antiviral medications until a therapeutic threshold is attained and symptoms are alleviated. Unfortunately, the allergy analogy would be a more fitting parallel in that every exposure to an allergen only makes the body more sensitive to each subsequent re-exposure, not less.
It was painful to observe one veteran in particular in the group be asked to relive his trauma. From the context of the intervention, it was clear that the group facilitator had asked him to do this before with the intent of eventually desensitizing the patient to future trauma reminders. This intervention strategy only had the opposite effect. The vet became angry and frustrated. He abruptly got up and left the group. Rather than facilitating healing, re-exposure therapy only deepened and extended the vet’s suffering.
Perhaps this technique is either not being utilized or is on its way out of the VA treatment protocol. It should be, because repeated re-exposure therapy further traumatizes and alienates the patient. As an alternative I would like to propose a treatment intervention for PTSD that I posit would be more efficient, cheaper and less painful for the wounded vet.
Re-exposure therapy does have its place in the treatment of PTSD but its use should be very limited and followed up by a positive reframing of the traumatic events. This can be done in the proposed steps described below:
- Inform the vet that he will only be asked to describe the trauma in detail once unless the patient wishes to revisit it at a later time. This gives the vet control of the relating of painful events at the outset. The vet also is informed that he can stop the narrative at any time. The vet has already lost enough control and this unsettling feeling need not be compounded.
- Once the trauma is recounted, positive reframing should begin at the very next session.
Essentially this process will establish a different meaning to the trauma. Rather than have the trauma defined by its horror, the painful memories can transform them into ones that transform the pain positively.
The suggested treatment is a variation of cognitive behavioral modification therapy or CBT. Any fundamental realistic cognitive alteration of painful memories can transform them into ones that transform the pain positively.
A basic example would be using the deaths of brother combatants as inspiration for making the life of the patient better rather than as a reason to engage in a self-defeating lifestyle because of survivor guilt. Every vet has his own story and can apply his or her traumatic experience in a manner which gives positive meaning to the loss.
One vet started a college scholarship in the name of the decedent at the latter’s high school. Another vowed to devote himself to the welfare of his wife and family that he formerly had taken for granted. A third inscribed the names of his killed-in-combat brothers on his motorcycle, which he raced in competition. The options are limitless and they need not include a slow descent into poverty, homelessness, broken families and suicide.
This simple treatment alternative can stimulate positive transformation within a few sessions. As stated, the trauma can be reenacted if relevant to the therapy but only at the behest of the patient. In this way control to an out-of-control life can be restored. The time to focus the treatment of PTSD on an affirmation of life rather than a repetitive punishing re-traumatization is long past due.
Soldier photo available from Shutterstock