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Sometimes the names of the trauma-focused therapies that folks come up with make me shudder all by themselves, they're so weirdly Orwellian.  That's the case for "reprogramming therapy," of which Accelerated Resolution Therapy (ART) is being hyped as the latest and greatest "cure."  Here's the headline: "Scottish nurses are to be trained in a treatment for post-traumatic stress disorder that works by reprogramming the brains of combat veterans." Though it sounds like a kind of Orwellian brainwashing, it's yet another version of Francine Shapiro's endlessly "promising" (no-longer-so-)new therapy, Eye Movement Desensitization and Reprocessing (EMDR).  EMDR and its variants have proved no more effective than any other trauma-focused therapy, which means they're moderately effective at relieving clinical symptoms in the short-term, for a very small segment of the population that suffers from PTSD (the 20% of women, and about 12% of men with no co-morbid psychological disorders). The description of how ART works is pretty weak: "The patient is asked to move their eyes back and forth while recalling traumatic events, a process which is thought to “unlock” the memory and enable the therapist to start a discussion aimed at detaching the associated negative emotions."

Since even variations on EMDR that don't use eye movements all seem to work about the same, it's pretty hard to argue convincingly that eye movements are the key to "unlocking" the memory.  The idea of "unlocking" is purely metaphorical anyway, since there's no proof that the memory mechanism (whatever it is) "locks" or "unlocks" at all.  Since we don't (even the neuroscientists) have good models for the mechanisms by which we remember, forget, revise or associate, "explanations" like the above are no better than "just so" stories, and often worse than no explanations at all.  Sterling University of the UK is teaming up with University of South Florida (USF) to implement ART, which was developed at USF. The rationale is a an allegedly successful study "carried out among 80 war veterans in the US found that the proportion showing signs of PTSD fell from 90 per cent to 17 per cent after four sessions or fewer. (When I found the study, it did not seem to include any war veterans. See next paragraph.) Incidences of depression in the same group dropped from 80 per cent to 28 per cent."  The people who report on science these days are so dim that they don't understand that stats like this are like giving half a baseball score.  A drop from 90% to 17% sounds pretty stunning, but it sure would be nice to know the response rate in the control group (if there was a control group), if they accounted for the placebo effect, and if there was a follow-up study to find out if the treatment had lasting effect.  So I poked around and looked for the study (not referenced in the article).

"Brief Treatment of Symptoms of Post-Traumatic Stress Disorder (PTSD) by Use of Accelerated Resolution Therapy (ART®)" wasn't hard to find. It was published in June of this year in a relatively new open-access journal called Behavioral Sciences. It's so new that it's published a total of 45 articles and I can't find any record of its impact factor.  This doesn't make it a bad journal, and it's from a reputable publisher, but a more robust study would have found a more prominent home.  So let's see what the study says...  1) Those selected for the study suffered from PTSD, but veteran status was not a criteria for inclusion; 2) 77% of the subjects were women, and 29% were Hispanic: those numbers are not representative of the population of British veterans (none of the subjects appeared to be vets); 3) 17.5% of the subjects dropped out before the end of the study, and 18.2% of the remaining subjects dropped out before the 2-month followup, which means that they collected full data on less than 70% of the full group of participants (54 people); 4) they excluded substance abusers (which would exclude 64%-84% of veterans with PTSD); 5) there was no control group, and all therapists were trained in and administered only ART therapy, which means that the effect of researcher allegiance on the patient was unaccounted for; 6) all data was self-reported.   So there is no way to know if the amazingly large effect they reported was due to ART or simply a product of entering any kind of very short-term trauma-focused treatment.  Section 4.2, "Possible Therapeutic Mechanisms," is pretty funny.  I've rarely seen a longer list of "may be.. postulate... may help... may occur... may simultaneously..." and so on.  The chain of conjecture continues for miles. Some of it is just plain pseudoscientific gobbledygook: "... ART involves an additional therapeutic element known as the 'Director' intervention that directs the patient to establish a new narrative to address 'unfinished business' in much the way that Gestalt techniques are used experientially to achieve positive results. Success of the intervention is determined by the therapist asking the participant to pull up the original distressful [sic] images, and reporting being unable to do so."  In light of the fact that the study did not include combat veterans, the final line of the paper is telling:  "Future controlled studies with ART are warranted, particularly given its short treatment duration, and in light of current heightened emphasis on health care cost constraints, as well as the very large clinical burden of treatment of PTSD being experienced from the lengthy wars in Iraq and Afghanistan." To me, this just screams:  "We're gonna sell this to the military!"  And, of course, the military bought it: the DOD paid for the initial research, and now ART® (don't forget that trademark!) is a product now offered to British war veterans.

PTSD Made Them Do It!

In Denver, a military veteran named Daniel Abeyta was arrested for allegedly shooting two women and blowing up a propane tank. The CBS Denver headline was "Neighbors say shooting suspect is vet with PTSD," but that's not mentioned in the article until the final paragraph: "Neighbors said Abeyta... suffers from post-traumatic stress disorder and is involved in a difficult marriage."  It's always fun when your neighbors diagnose you for the news media and then the news affiliate headlines the hearsay. In other news, 43-year-old Dinalynn Inez Andrews Potter, a retired Navy vet, allegedly jumped on stage and clobbered elderly soul singer, Lester Chambers when he sang a song dedicated to murdered teenager Trayvon Martin. Apparently Potter's claim she has PTSD makes this "not a racial attack" in the eyes of the arresting officer, even though Potter yelled, "It's all your fault, you caused this shit," before she knocked the frail singer on his ass.  This "It's not racism, it's PTSD" stuff is just silly. It's not like the two are mutually exclusive.  PTSD doesn't change your political beliefs or give you prejudices you didn't have in the first place, even though it might remove your inhibitions to acting on them.

This was originally published on my argumentengine site...

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Comment Preferences

  •  Tip Jar (8+ / 0-)

    "If you fake the funk, your nose will grow." -- Bootsy Collins

    by hepshiba on Sat Aug 17, 2013 at 02:33:07 PM PDT

  •  About reprogramming... (1+ / 0-)
    Recommended by:
    hepshiba

    PTSD treatment is all about retraining the limbic system. I don't think it sounds Orwellian at all. EMDR addresses the integration errors that happen when traumatic memories get recalled. This is all good news.

    This is an important series. Thanks for writing it.

    Breathe in. Breathe out. Forget this, and attaining enlightenment will be the least of your problems.

    by rb137 on Sat Aug 17, 2013 at 03:08:35 PM PDT

    •  Sorry, but we don't have much (3+ / 0-)
      Recommended by:
      rb137, atana, pvasileff

      evidence that "retraining the limbic system" (which itself is very vague) is an effective treatment for PTSD.  The narrative: "EMDR addresses the integration errors that happen when traumatic memories get recalled" doesn't actually mean anything. It's jargon in defense of jargon.  I'm not saying this to be unpleasant.  I'm saying it because EMDR and other trauma-focused treatments work (if they do work) for reasons we don't actually understand.  Telling ourselves we understand them by using metaphors (like "integration errors") doesn't clarify anything.

      So in my opinion there's no "good news" here (especially since there was no control group and so there's no evidence this treatment works at all).  I'd love a proven, evidence-based, effective long-term treatment for PTSD (though I'd far prefer preventing it) but we're far, far away from such a thing. Being clear and honest about that is, in my opinion, the best policy.

      "If you fake the funk, your nose will grow." -- Bootsy Collins

      by hepshiba on Sat Aug 17, 2013 at 03:48:26 PM PDT

      [ Parent ]

      •  We do, actually. (0+ / 0-)

        There is plenty of it. But I don't want to have a sparring match with you about it. Much of the evidence is collected in the military. If you really want, we can share literature about it.

        Trauma is part of the human condition. You can't prevent it. Not as a rule.

        Breathe in. Breathe out. Forget this, and attaining enlightenment will be the least of your problems.

        by rb137 on Sat Aug 17, 2013 at 03:59:33 PM PDT

        [ Parent ]

        •  I'd be happy to look at literature you think (1+ / 0-)
          Recommended by:
          atana

          ... documents your claims.  But odds are I've seen it already. I've had sources in the military sharing literature for the last 25 years.

          And your claim we "can't prevent it" doesn't make any sense, unless you don't believe in, say, the Violence Against Women Act (lots of evidence that this actually did reduce violence against women).  Of course we can prevent trauma -- not all of it, but a whole lot of it.  We reduce trauma when we achieve the social justice goals that we struggle towards.  We reduce trauma when we prevent or stop unnecessary war. This "human condition" argument holds no water.  The capacity to be traumatized is, of course, part of the human condition. And we can't prevent natural disasters (though we can reduce trauma by preparing for them better) or random accidents (though we can improve safety conditions to reduce the number of them).  

          What's the point of saying it's "part of the human condition"?

          And I gotta ask you what a real PTSD cure would even look like.  The military version of the answer gives me the willies.

          "If you fake the funk, your nose will grow." -- Bootsy Collins

          by hepshiba on Sat Aug 17, 2013 at 04:34:51 PM PDT

          [ Parent ]

  •  if I may offer an observation about PTSD (1+ / 0-)
    Recommended by:
    hepshiba

    (aside from the unfortunate media proclivity for labeling every veteran involved in a violent incident as suffering from PTSD;  Hollywood has only just begun relinquishing the crazed Viet Nam veteran as an industry icon)

    It seems from a mole's eye viewpoint of a layman that there are many different causes ranging from witnessing a traumatic event to being involved in a traumatic event (such as shooting a buddy or bystander by accident) or else experiencing the trauma (such as being blown up by an IED).  It would seem, given the various geneses of PTSD, that one size fits all therapy would be doomed to failure.  

    Of course we are behind the curve in treating PTSD since the VA decided that there was no such thing as PTSD during VN, despite its being well documented since the Civil War and its having been treated in other generations as shell shock or combat fatigue.  (the same way it was decided that Agent Orange was basically harmless).  Given that there are some estimates that as many as 25%-33% of veterans suffer from PTSD due to the long terms effects of repeated deployments, it would behoove us as a nation to get it right this time in treating our vets as they deserve

    •  You're exactly right about there being (2+ / 0-)
      Recommended by:
      entlord, atana

      no one-size fits all therapy.  Treatments that seem moderately effective for rape survivors (exposure therapy) are less effective for combat vets, for example. And no treatments are proven effective for the vast majority of those with PTSD.  Tests are almost always done on those with no comorbid disorders, but the large majority of those with PTSD have at least one comorbid disorder.

      Since I'm on the public health side of the argument, I believe that the best way to cure PTSD is to prevent it from happening in the first place. Anything else is just going to be a holding action.

      "If you fake the funk, your nose will grow." -- Bootsy Collins

      by hepshiba on Sat Aug 17, 2013 at 03:52:28 PM PDT

      [ Parent ]

      •  no argument from me there but so long as our (1+ / 0-)
        Recommended by:
        hepshiba

        nation continues to send our troops into combat situations with multiple deployments, we will continue to see PTSD.  If anything our 21st Century conflicts seem to generate more PTSD WIAs than previous conflicts

        •  It's hard to tell if there are more or fewer (0+ / 0-)

          psychological casualties of modern wars.  Personally, I tend to doubt it, though the way that we deal with those casualties is very different.

          "If you fake the funk, your nose will grow." -- Bootsy Collins

          by hepshiba on Sat Aug 17, 2013 at 05:34:26 PM PDT

          [ Parent ]

  •  Prevention may be easier than "cure" (0+ / 0-)

    Obviously preventing the traumatic causes of PTSD is the best solution of all, but it may be possible to identify biomarkers for high-risk people. While many people have traumatic experiences, only 10% or so of those people develop PTSD. Predisposing factors are: child abuse and childhood exposure to violence, certain genetic polymorphisms in GABA A receptor, RGS2, FKBP5, and some other genes.

    So it may be possible to develop a genetic test to screen for high risk individuals.

    •  The whole concept of using (0+ / 0-)

      biomarkers to predict PTSD is really disturbing.  I'm working on an article about that right now. I'll give you a couple of my concerns.

      First, the research on biomarkers for PTSD is very thin, but the government has just dumped a ton of money into a project to identify them.  The military, of course, is thrilled because a screening project is just what they need.

      Second, screening is not "prevention" except in circumstances like military induction.  Prevention of violence is the only real prevention.

      Third, the cluster of symptoms which we describe as PTSD causes terrible problems in the lives of the people who have them, and of course it would be a great idea if those symptoms could be relieved (which screening would not do).  But the claim that "only 10%" develop PTSD after trauma (which is not  accurate for all traumatized populations, btw) is uncomfortably close to saying that trauma isn't bad for people unless they're part of the unlucky 10% that develops PTSD.

      The attitude of the military-medical complex seems to be that violence and mayhem are fine, as long as we can keep our troops high-functioning.  Even if this were an ethical position to take on soldiers (which I don't believe it is), it's not an ethical position to take on the vast majority of PTSD survivors, most of whom are not soldiers.  How do we use biomarkers to "screen out" rapes, abuse, etc?  

      Not to mention the merry hell that insurance companies would raise about giving coverage to people with biomarkers that predispose them to PTSD.

      "If you fake the funk, your nose will grow." -- Bootsy Collins

      by hepshiba on Mon Aug 19, 2013 at 05:06:33 AM PDT

      [ Parent ]

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