Disorders and Treatment
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- Case Studies
This post by Laura Kerr, PhD, is being reprinted from her blog with permission.
David J. Morris, a former Marine infantry officer and a reporter in some of the most violent regions of the Iraq war, blacked out while watching a movie and ran out of the theater, only to regain awareness of himself in the lobby as he anxiously scanned other patrons for improvised explosive devices (IEDs). Morris’ girlfriend later told him an explosion in the movie precipitated his flashback.
While in Iraq, Morris had nearly been killed by an IED, and he saw two National Guardsmen killed by them. He was nearly shot down while riding in a helicopter, and with fellow Marines, withstood shelling for seven days. He had many reasons to be triggered by an explosion, even an imaginary one in a movie.
When Morris sought treatment for posttraumatic stress disorder with the Veterans Administration (VA), they recommended prolonged exposure therapy, a form of trauma treatment that attempts to help people like Morris become desensitized to their trauma triggers. In his New York Times article, Morris gave the following description of prolonged exposure therapy:
“The promise of prolonged exposure is that your response to your trauma can be unlearned by telling the story of it over and over again. The patient is asked to close his eyes, put himself back in the moment of maximum terror and recount the details of what happened. According to the theory, the more often the story is told in the safety of the therapy room, the more the memory of the event will be detoxified, stripped of its traumatic charge and transformed into something resembling a normal memory.”
Morris expected, “given enough time and enough story ‘reps,’ when I opened my eyes again, I wouldn’t feel forever perched on the precipice of a smoke-wreathed eternity. I wouldn’t feel scared anymore.”
Just the opposite happened. Instead of “unlearning” his traumatic stress response, becoming desensitized to reminders of war, he was flooded and overwhelmed by the therapy:
“But after a month of therapy, I began to have problems. When I think back on that time, the word that comes to mind is ‘nausea.’ I felt sick inside, the blood hot in my veins. Never a good sleeper, I became an insomniac of the highest order. I couldn’t read, let alone write. I laced up my sneakers and went for a run around my neighborhood, hoping for release in some roadwork; after a couple of blocks, my calves seized up. It was like my body was at war with itself. One day, my cellphone failed to dial out and I stabbed it repeatedly with a stainless steel knife until I bent the blade 90 degrees.”
Morris was told prolonged exposure therapy worked for about 85 percent of the VA patients who used it. However, in his book The Body Keeps The Score (2014), psychiatrist Bessel van der Kolk discussed a study conducted in the early 1990s that contradicts the VA’s statistics. In this study, led by Roger Pitman, Vietnam veterans were asked to repeatedly talk about their experiences during wartime. However, Pitman had to stop the study prematurely
“because many veterans became panicked by their flashbacks, and the dread often persisted after the sessions. Some never returned, while many of those who stayed with the study became more depressed, violent, and fearful; some coped with their increased symptoms by increasing their alcohol consumption, which led to further violence and humiliation, as some of their families called the police to take them to the hospital.”
Van der Kolk also shared:
“A 2010 report on 49,425 veterans with newly diagnosed PTSD from the Iraq and Afghanistan wars who sought care from the VA showed that fewer than one out of ten actually completed the recommended treatment. As in Pitman’s Vietnam veterans, exposure treatment, as currently practiced, rarely works for them. We can only ‘process’ horrendous experiences if they do not overwhelm us. And that means that other approaches are necessary.”
Personally, I am not a fan of exposure therapy. I think it’s too risky, as these studies suggest. I feel certain it would have caused flooding for me too had it been used to treat my flashbacks of childhood sexual abuse. (Fortunately, I was able to use EMDR instead.) After one session I would have never returned, and sadly, would have lost trust in psychotherapy and the support I needed to heal.
Humans are impressively resilient and adaptive. We can manipulate ourselves and our bodies in extraordinary ways, even detrimentally, and continue to survive. (Think of foot binding of women in China.) At birth, our brains are profoundly underdeveloped, increasing in size by 300 percent over the next two decades of life (Linden, 2007). Maturation involves gaining the biological, psychological, and behavioral capacities that allow us to continually adapt to physical and social environments that are also malleable and ever-changing.
Because we are ‘plastic’ by nature, I think it is safe to assume there are many ways to alter ourselves in our attempts to overcome the fallout of traumatic events. Exposure therapy is one option among many available for dealing with the aftereffects of trauma, albeit one that works for some people. Yet, because we are malleable and adaptable, there are also numerous reasons to use a treatment besides that it ‘works’ for some people — we can have reasons for treating trauma other than just stopping flashbacks.
For example, instead of making the primary criteria for success that a treatment ‘works,’ we could also think about how treatment alters people, and in turn impacts the social fabric of our communities. We might ask what kind of people we become when we are desensitized to traumatic reminders. We might wonder if, from an evolutionary standpoint, it is even safe to become hardened to memories of war, rape, and abuse. We might also wonder if there is an implicit assumption at work here — that overwhelming fear is the central problem to address, rather than the conditions that lead to war, rape, and abuse. We might question, If we become desensitized to our fear, do we also become desensitized to violence? We might ask, What is more powerful than profound emotions and visceral reactions to motivate us to seek meaningful change? How we treat trauma likely has farther reaching impact than ‘just’ reducing individual experiences of traumatic stress.
I strongly believe trauma treatments should protect our capacity for vulnerability and empathy, while also helping us regain the ability to modulate our defense reactions. We are likely most resilient and wise when we can defend ourselves and loved ones when the need arises, and the rest of the time (preferably, most of the time) live peaceful, engaged, and meaningful lives. And we need trauma treatments that can help us regain this full expression of our humanity following traumatic events or conditions.
Tune in next week for Part 2 of this post….
Linden, David J. 2007. The accidental mind: How brain evolution has given us love, memory, dreams, and God. Cambridge, MA: The Belknap Press of Harvard University Press.
Kolk, Bessel van der. 2014. The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma. New York: Viking.
© 2015 Laura K Kerr, PhD. All rights reserved.
Laura K. Kerr, PhD is a mental health scholar, former trauma-focused psychotherapist, and soon-to-be “trauma coach.” Read more of her reflections on trauma, healing, and society at her blog, Trauma’s Labyrinth.
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