Talk isn’t cheap: Talk therapy is highly valuable in trauma treatment.
Capt. Garrett Boyer, Psy.D., Deputy Chief of Embedded Behavioral Health, Fort Stewart, GA
As a psychologist, it amazes me how frequently I sit down with service members who have had a traumatic experience but have never spoken about it with anyone before.
A recent article by Ellen Barry of The New York Times cited research which found that traumatic memories associated with posttraumatic stress are processed as present experiences in the brain. If this is true, then my patients who saw horrific things 10 or 20 years ago in Iraq or Afghanistan have experienced those events as ever-present since that time – which is something remarkable to imagine.
However, the research highlighted in the Times article shows talk therapy is the most valuable approach to make a traumatic experience seem like a memory instead of a present experience.
The research concluded that while the hippocampus is responsible for much of the memory functioning in the brain, when research participants thought of their traumatic experiences, the hippocampal region did not light up on brain scans. Instead, the posterior cingulate cortex was more active. It was as though the brain was operating in a state of present experience instead of recollecting traumatic events like a bad memory. Dr. Ruth Lanius directs PTSD research at the University of Western Ontario, and she is quoted in the Times article saying, “Traumatic memories are not experienced as memories as such, but as fragments of prior events, subjugating the present moment.” This reality is something that many service members and veterans live with on a daily basis – constantly reliving the experience of trauma.
No wonder they are not inclined to talk about it with anyone! From a biological standpoint, their avoidance strategy makes some sense. If trauma victims experience elements of traumatic memories as something actively happening, it is understandable that they would want to avoid people, places, or things associated with the trauma.
The trouble, however, is that traumas do not process like regular memories. Just because patients avoid “triggers” does not mean that traumatic experiences simply go away. On the contrary, patients have described the traumatic memories playing in their minds like an endless film loop for years. Because of this, they can appear anxious, tense, avoidant, hypervigilant, or disconnected, which can cause problems at home or at work. Many turn to illicit substances or alcohol to dull the senses, but these don’t help a patient work through a traumatic experience.
What is to be done then to help patients cope with the trauma?
Research has consistently shown the most effective approach in the treatment of trauma is actually talk therapy, especially those approaches such as cognitive processing therapy, prolonged exposure therapy, or eye movement desensitization and reprocessing, which require victims to recall their traumas in vivid detail. How can this be? It seems almost counterintuitive asking patients to recount the narratives from the worst moments of their life.
While it can be acknowledged that trauma treatment is taxing and stressful, both for the patient and the therapist, it is so valuable because it helps the patient consolidate the traumatic experience as a memory which can then be stored in the hippocampus and retrieved like any other memory. With the exposure techniques, the brain and body eventually become synced up, and the patient starts to have a realization: Memories cannot hurt me.
As one patient put it to me in a session, “Memories are just thoughts like any other. By themselves, they are neither good nor bad – and even if the content of the memory is bad, I just have to remember that it is only a memory, and I am in no danger here and now.” An astonishing statement from a service member who only two months before treatment was reluctant to leave the house and felt perpetually irritable and “always keyed up.” The patient attributed the profound, life-changing realization to the exposure therapy.
After nearly a decade of living with the horror of combat trauma, the service member is beginning to experience life anew. They can be present to their spouse and family in a way that was unimaginable before. Things are going better at work. They can get a good night’s sleep. You cannot put a price on that! Indeed, talk isn’t cheap when it comes to exposure therapy. Though difficult, it may be the most valuable thing you ever do if it opens the door to transformation and a life of peace and freedom.
Army Capt. Garrett Boyer is an active-duty psychologist at Fort Stewart-Hunter Army Airfield in Georgia. DISCLAIMER: "The views expressed in this editorial] are those of the author and do not necessarily reflect the official policy or position of the Defense Health Agency, Department of Defense, U.S. Army, nor the U.S. Government."
| Date Taken: | 02.28.2024 |
| Date Posted: | 02.28.2024 09:00 |
| Story ID: | 464860 |
| Location: | FORT STEWART, GA, US |
| Web Views: | 461 |
| Downloads: | 0 |
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