Victims of PTSD have more than just one treatment available to them, but they may not have been informed about these. They include present-centered therapy (PCT), virtual reality exposure (VRE), Narrative Exposure Therapy (NET), hypnotherapeutic olfactory conditioning (HOC), and yoga.
Proponents of what has become widely known just as “exposure therapy” may not know that it has a high attrition rate and that many therapists don’t use it at all. Some of those in the field of PTSD treatment use exposure therapy to flood the participant with content and emotion known to have triggered a reaction in the past. The goal is extinguishing the reaction by desensitizing. But one size doesn’t fit all when it comes to therapy modes.
In addition, mental health workers who have a veiled obligation to other parties than the consenting participant can retraumatize the victim: the flooding doesn’t contribute to healing, but to continued, extended, and amplified toxicity, as participating psychologists would already know from their training.
One proven method is Narrative Exposure Therapy. It has demonstrated that it is sensitive to culture; can be made available in geographically remote or medically underserved areas; and benefits even victims of politically-motivated programs, including torture, even years later and well into senior age groups.
Narrative Exposure Therapy, has been studied extensively by vivo, according to their website “an alliance of professionals experienced in the fields of psychotraumatology, international health, humanitarian aid, scientific laboratory and field research, sustainable development and human rights advocacy. vivo is an independent non-profit organization committed to the provision of services to those who need it most regardless of their racial, ethnic, sexual, religious or political affiliations.”
Narrative Exposure Therapy has been used with excellent results in countries where therapy may not be readily available, where entire populations may have been devastated by events, and where politically-motivated programs, torture, and psychological as well as physical violence have been factors.
According to the vivo website, those who survive politically-tinged violence are often reluctant to talk about it. Inability to speak out obstructs personal emotional processing of the issues and restricts information that provides testimony for human rights violation prevention and accountability. Narrative Exposure Therapy gives victims back both of these components of recovery.
Through NET, those who have witnessed human rights violations are able to piece together the memories of their experiences, resonating with their truth. In situations where truths have been deliberately withheld from them, when only pieces of information, sometimes false, are allotted to their various contacts, or when free, private conversation with others has been deliberately curtailed, recovery has been deliberately hindered or made impossible. They have been hostages in more ways than one.
Narrative Exposure Therapy allows victims to understand the gaps in their own stories. It accomplishes this not only by rational thinking processes like induction and deduction, but also by exploring the situation they lived through and listening to their speaking self in conversation with their silent self. NET participants arrive at a narrative that gives coherence to their previously brief and sometimes disjointed memories of the traumatizing events.
One of the issues in PTSD is that some of the situations are what communities sometimes say are “unspeakable.” Generally that word is used in conjunction with murder, rape and other sex crimes, torture, and extreme violence, as well as natural disasters with far-reaching consequences like famine, global conflicts like war or major national disruptions, and the sanctioning of human rights abuses. To facilitate speaking about these is to open the door to solutions. That is one reason that groups who don’t want real solutions to human rights issues may oppose programs in which victims speak out.
According to vivo, Narrative Exposure Therapy does not usually require more than three or four sessions, and it doesn’t require an office setting. Its aim is the fostering of emotional processing of traumatic memories and emotional relief. In cases of war or natural disasters, it also creates a narrative that promotes and preserves a sense of place and community.
NET also makes the trauma meaningful, because it opens the door to justice on personal, local, national, and global levels through careful documentation of the condition of the participants and the abuses of others that led to it. It is culturally sensitive, and studies have shown that it has a high rate of acceptance in many countries.
Virtual reality exposure therapy was concluded to be a better instrument for helping PTSD patients than the more traditional exposure therapy. VRE therapy is flexible, and can be used for many causes of PTSD in a diverse population of victims. A study, published in February, 2010, took place at the Universitat Jaume I de Castellon, Spain that demonstrated this and found that the attrition rate for exposure therapy is high and clinicians don’t generally use it.
Another cognitive therapy studied for PTSD uses a problem-solving method. Also published in February, 2010, a study was done at the Mental Health Service Line, VA Medical Center-Atlanta. Like the study from Spain, it was published in the journal Cyberpsychology and Behavior. According to the abstract, eleven Vietnam veterans with war-related PTSD were given either computer-based virtual reality exposure therapy or “present-centered therapy (PCT) that avoided traumatic content and utilized a problem-solving approach.” There were no significant differences between the results.
The abstract to the Atlanta study reminds readers that PTSD sufferers have emotional arousal and avoidance as symptoms, that these cause distress, and that in turn these can impair their ability to function in their own lives as they usually would. Vivo as an organization is concerned that implementation of ad hoc approaches to trauma sometimes not only doesn’t help, but may actually harm participants. In this regard, according to their statistics, NET participants at the one-year mark were better off that those who received supportive counseling or psycho-education. The areas studied were social, economic, and emotional variables.
Hypnosis has been studied recently as a mode of intervention. In the abstract of an article dated July, 2010 in the International Journal of Clinical Experimental Hypnotism, the Mental Health Division of the Israeli Defense Forces said combat veterans sometimes have an olfactory element to their PTSD. In six sessions, a group of 36 outpatients were treated with hypnotherapeutic olfactory conditioning (HOC). There were significant reductions in symptoms in 58% percent of participants, as well as significant improvement in depression and dissociative experiences. These improvements were still there at the 6-month and 1-year mark.
In addition, yoga helps depression in PTSD patients. In a study in Australia, Janis Carter, M.D., did a six-week study that involved having nine men who suffered from PTSD take yoga once a week. Practicing at home was not the norm in this group. All nine were severely depressed the first week on a psychiatrist-scored scale, at the three-week mark several had no signs of depression, and at the six-week mark, none of them showed even mild depression.
So there are choices available, some of them internationally based with both results and investigators available to interested parties here. PTSD is not just an issue in the United States, exposure therapy is not the only therapy available, and the individual’s voice is paramount in treatment modes for PTSD just as it is in any treatment mode. Therapy is about the individual, not about the therapist.
In the United States, Elizabeth Weiling, Ph.D., a professor in the Department of Family Social Science at the University of Minnesota, is currently working with associates at the University of Konstanz, Germany, where Narrative Exposure Therapy was developed. They are collaborating to implement and test new interventions for trauma for international use. In the United States, she is collaborating with colleagues at the Oregon Social Learning Center and the Center for Victims of Torture,
Got a story to share about recovery from PTSD? Contact Linda at [email protected]
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