The Ugly Truth about Prolonged Exposure: A Case Study in Medical Ethics
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Episode 007: Assuming you don't believe that that past 100 years of psychotherapists were actually trying to cause harm to patients, you'll soon better understand how mental health interventions are a double-edged sword. History demonstrates that the Law of Unintended Consequences applies here. Before we get into the weeds in prolonged exposure, let's first start off by discussing unintended consequences of a psychotherapy for PTSD that I actually do like and agree with - Cognitive Processing Therapy. Now, I'm putting references here so that you can follow the research trail for yourself if you need proof to show to your circle of influence. In CPT, there are a couple of writing assignments at the beginning: The Impact Statement followed by the Trauma Account. As opposed to Prolonged Exposure Therapy, Cognitive Processing Therapy does this brief, one-session account of the details of what actually happened during the trauma. The intent is to use the information explicitly during later stuck point work. The knowledge in that situation was worth it, we thought, to expose the patient to the anxiety, nightmares, flashbacks and sometimes depression and relapse with substances of abuse - all related to having to tell their story. For them, they are re-living it. Because they are. No Trauma Account Needed in PTSD Therapy Resick 2015. Cognitive Processing Therapy (CPT) without a trauma account written by the PTSD patients versus group present-centered therapy. 2. A residential PTSD/Traumatic Brain Injury program compares CPT with no written account vs. one group that did have a written account.Download 3. Resick-et-al.-2008. A randomized clinical trial to dismantle the components of Cognitive Processing Therapy for PTSD in female victims of interpersonal violence.Download 4. Resick-et-al-2017. Cognitive Processing Therapy had no written trauma account when done in individual and in group.Download Many years later, we finally start asking the question - do we really need to do the trauma account? Here? Now? What if we do everything else in CPT, but leave that part out? Guess what they found. That's right, the reliving of every excruciating detail of the trauma wasn't necessary to relieve the suffering and improve quality of life! The lesson isn't that I instinctively didn't like the trauma account meetings I attended in training where veterans went through every detail. My resistance wasn't personal for me, for my ECS was not yet totally out of balance. I could handle and cared passionately for the work I was doing. I was ok. No, the problem was I saw the torment through their eyes and their bodies were reliving it. We were doing this to them. And we still are - today. Just because a paper comes out that says we don't have to doesn't mean people stop the harm overnight. Of course, I firmly believe in an individualized treatment plan and this here is not medical advice per se. Trauma Accounts should be done on a case-by-case basis where the patient has every bit of informed consent as what I'm presenting in the entirety of this podcast, not having simply signed an informed consent piece of paper. There are many options for PTSD symptom relief Those that need body-based approaches are largely ignored by mainstream psychiatry. However, a few techniques have made it into the halls of military facilities for post-war reset programs. Acupuncture, Reiki energy healing, mindfulness meditation are good, but they are only the tip of the iceberg when it comes to different types of techniques that will work. If you ask me, I think the clinical scientists today are waiting a bit too long for randomized trials with the underlying science has already been worked out to show how similarly body-based techniques really work the same way. For example, massage, acupuncture, putting your hand on a sore spot, using a heating pad, and a doing a hot water soak all do the exact same thing to a bruised elbow - they increase capillary bl...
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