Last week Federal Minister for Veterans Affairs Dan Tehan launched the trial of a new intensive treatment program for current and former Australian Defence Force (ADF) members who have PTSD. It’s great to see the Australian Government trying to do something positive to help the men and women who serve our country, but it also raises some questions in the PTSD therapy field which currently seems to be experiencing something of a divide. In one corner the more traditional CBT exposure therapy proponents advocate the much researched cornerstone treatment methods and in the other there’s much ado about somatic therapies, body based approaches, and, the highly-claimed and researched EMDR (Eye Movement Desensitisation and Reprocessing). The Minister’s four year partnership project grant through the National Health and Medical Research Council (NHMRC) was awarded to DVA, Defence, and, the University of Melbourne to conduct the RESTORE (Rapid Exposure Supporting Trauma Recovery) trial, and Phoenix Australia – Centre for Posttraumatic Mental Health is leading the project on behalf of the University. Interestingly Phoenix also endorses EMDR as an effective treatment for PTSD so its going to be interesting to see the trial results (this is a rapid and therefore shorter period of exposure) and to find out how they shape future directions in PTSD treatment.
While both exposure therapy and EMDR are evidence based therapies, trauma experts like Bessel van der Kolk give good reasons for moving PTSD therapy away from cognitive therapies (Exposure Therapy is a form of CBT) – and ‘talking about the problem’ – towards therapies that focus on body awareness and processing and integrating traumatic material. His book, The Body Keeps the Score, has been praised by EMDR founder Francine Shapiro, as well as others trauma authorities like Peter Levine, Judith Herman and Jon Kabat-Zinn. He argues that traumatic stress has very little to do with cognition as it emanates from the emotional part of the brain that is rewired to constantly send out messages of danger and distress, with the result that it becomes difficult to feel fully alive in the present. While acknowledging that talk can enable the individual to gain a better perspective of what happens (especially in the first few days after a trauma) he points out the mistaken notion that trauma is primarily about memory or the story of what happened.
Van der Kolk is a big advocate of EMDR having experienced it in therapy himself and regularly using it in his work with people recovering from PTSD. Being part of the only NIMH-funded study on EMDR he states the results of the 2014 study were more positive than any published study of those who developed PTSD in reaction to a traumatic event as an adult. This incredibly successful EMDR trial revealed that the impact of trauma is in the somatosensory self – trauma changes the insula, the self awareness systems which is why traumatised people often become insensible to themselves and find it hard to experience pleasure and to feel engaged. He also argues the reason why many veterans drop out of prolonged exposure therapy (PET) is probably because they are being retraumatised. Perhaps the briefer exposure therapy used in RESTORE will counteract this fallout but will it improve veterans’ ability to ‘feel’ and be present in the world as does EMDR? Let’s just hope the trial and its findings will offer hope and restoration to people who really need it. As Bessel van der Kolk knows from his extensive research, EMDR really works for PTSD – let’s hope rapid exposure therapy does the same.