Research indicates the importance of stories or narratives in working through catastrophic experiences. To learn from and make sense of catastrophic loss, our brain naturally formulates an account that describes what happened and why. We are especially likely to develop narratives when an event is surprising or unpleasant, or when it violates our basic expectations. Such narratives help us find meaning in our lives, and especially in our losses, which in turn, facilitates healing. Given the obvious importance of the central role of such narratives, you might wonder why traditional psychology—which regularly uses life narratives in various ways—has had such a difficult time dealing with PTSD.
Perhaps the reason is overreliance on a one-sided story. In general, the traditional healing methods aim to fight fire with fire: they return again and again to the narrative of the terrible things that happened to the sufferer in the past, and then to try to desensitize him or her to their enduring impact.
In traditional PTSD therapy, clients must relive the trauma over and over again. Although this may be an effective treatment for some, we’ve found that it is more often detrimental to many of our clients. Reliving trauma—which the PTSD sufferer already does every moment of every day, awake or asleep (without any prodding from a therapist) is painful. It hurts. And we all want to avoid pain. To go back in time to the bad things we experienced first hand, or worst, that we caused, is painful, yet the present and future scenarios seem hopeless. It is not surprising that outcomes from traditional PTSD therapy have been only partially effective, at best.
Cognitive Behavioral Therapy (CBT)
CBT, a blend of behavioral therapy and cognitive therapy, focuses on the here and now. To date, it has been the therapy with the most success in overcoming trauma. A talk-based therapy, CBT aims to problem-solve around intense abnormal emotions, behaviors, and thoughts through a methodical, goal-oriented approach. Used in both individual and group therapy, the techniques often include keeping a journal of events and related feelings, thoughts, and behaviors, and implementing different reactions and behaviors.
Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy, and
Virtual Reality Therapy
CPT, prolonged exposure therapy, and a new modality called virtual reality therapy are currently employed by the Veterans Administration to treat veterans suffering from PTSD. In all three processes, the veteran relives past military traumas in an attempt to extinguish the negative emotions associated with her or his traumatic military experience. The majority of our veteran clients reported that these therapies made them regress in gains they had been making through the time perspective therapy process. They reported an increase in nightmares, flashbacks, social isolation and anger, as well as suicidal and homicidal thoughts.
Drug Therapy
For the past several decades, drug therapy has been a common approach to the treatment of anxiety, depression, trauma, and other behavioral disorders. The assumption is that the medications will break up the nonfunctional pattern of thought, allowing the individual’s mental health to return naturally. But drugs do not get to the root of the problem. They are a temporary solution that alters symptomatic behavior, but drugs do not address the cause. Predictably, the behavior often returns when the drugs wear off, leaving the PTSD sufferer feeling like nothing will ever change, or simply wanting to use the drugs to mask the pain. Also, when drug therapy does not work, that further promotes a fatalistic perspective that nothing can alter the deeper suffering being experienced. It also increases reliance on turning to drugs to self medicate for other problems.
Does critical incident stress debriefing work to head off
Time Perspective Therapy Transforms Past, Present and Future
Time perspective therapy takes a different approach entirely. It begins by respecting the trauma for what it can teach us rather than dwelling on how it harmed us. Time perspective therapy understands that we each have a unique time perspective narrative based on our personal experiences, and this perspective is the lens through which we view our lives. But our experiences do not need to lock us into a particular way of seeing the world and our place in it—particularly when that way of seeing things is destructive to ourselves and to those we love. No matter what our experiences have been, we always have a choice. By changing our time perspective, we can change our lives. For PTSD sufferers, this means gaining the real and lasting ability to move beyond the terrible past and live in a healthy balance of past, present, and future.
The realization that we always have the choice to change how we view the times of our lives is essential to this orientation. Over the course of this exciting new therapy, PTSD sufferers move away from a narrow focus on the traumatic past and a cynical present denial about the possibility of ever achieving a hopeful future, instead journeying toward a balanced time perspective in which it seems possible once again to live a full and promising life in the present—learning to “make time” for what matters most—family, friends, fun, nature, hobbies, and constructive work.
This concept is reflected in the ordinary language that we time perspective therapists use. Most people suffering from PTSD have already been labeled as anxious, depressed, or even “mentally ill.” When they hear these words, and identify with them, the possibility of ever emerging from such a state feels very distant. We help clients reframe their ‘‘illness’’ as a “mental injury.’’ Next,we recast their depression and anxiety as a ‘‘negative past’’ that they can replace with a ‘‘positive present’’ and a ‘‘brighter future’’—and ultimately with a balanced time perspective. This view may seem overly simplistic, especially to those of us trained in traditional psychotherapy.
But to PTSD sufferers (Vets, first responders, sexually abused, and survivors of natural disasters and fatal accidents), the idea of having a forward-leaning new framework, a hope-filled narrative, with which to understand and work on their issues most often comes as an enormous relief and a welcome ray of light that permanently illuminates the darkness in their lives.
For more information on the effects of PTSD, see The Time Cure: Overcoming PTSD with the New Psychology of Time Perspective Therapy (Zimbardo, Sword & Sword, 2012, Wiley Publishing,) and for strategies to reduce stress and improve communication, visit www.timecure.com and www.lifehut.com.