Hello, my name is Johanna, and I welcome you to the Johanna Draconis - The Deconstruction Of C-PTSD podcast.
Today we are going to talk about the different therapy methods and later on sadly about the abuse that can happen with them. Not every therapy is for everyone, different traumas work best with different therapies.
I will not touch on medications, as there are too many factors to them and I wouldn’t recommend any medications on long distance. This is clearly out of my field of expertise.
Instead I hope to give some clarity and overview, which therapy might work best with you and your form of PTSD and symptoms.
First I am going to explain the problem with psychological diagnosis at the moment.
After that we are going to go over the the therapy methods Cognitive Behavioral Therapy (CBT), Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE or PET) in this episode.
I had to split the episode, as the topic was more extensive than I originally thought it to be.
Problem with psychological diagnosis
But before all of that, I just want to note the special difficulty that people face treating or having psychological problems: There is no effective measurement method.
Imagine having to diagnose people by just what they say, even when they are 100% truthful, they still might give false information. Also the information they can give is limited.
For an example: “My stomach hurts!” …. Now that might be a hint for some bad food, stress up to a potential lethal illness. Most likely the patient can’t give additional information.
Imagine our success rate with those diagnoses IF we just could ask people and had no way of testing them. The importance of that can’t be overstated.
There are now ways being developed to get a visual representation (as in form of brain scans, etc.), so that the doctor or therapist has a way to test for mental illnesses.
I think this is very important and a step in the right direction and I hope we can soon easily discover mental illnesses this way. Especially since often people don’t even know they have one.
At this point and age, the therapist or doctor or whoever can only help you as much as you can give him or her information. That limits them greatly.
But before any therapy can effectively take place, you need to stabilize yourself, but we talked about that already in Episode 5 - Daily counter measures.
Cognitive Behavioral Therapy (CBT)
The first therapy we take is the most classic therapy, the Cognitive Behavioral Therapy or CBT for short, which most psycho therapies usually are, so it is kind of an umbrella term.
This therapy aims to change bad though patterns that disturb you from living a good life. Basically talking you out of your problems and getting rid of them and changing your behavior and way of thinking.
We humans are social beings, that, if we talk about something with someone, will reopen and re access a memory package or topic package, etc.
The therapist in this therapy version of course just not talks, but talks you through several scenarios or uses different methods to try to solve the issue.
Important point: He is leading the conversation through his questions and gives the directions and of course tries to counter negative effects, feelings and the like as good as he can.
Talking about a topic can also help us get new insights and view the topic form a new light and therefor be able to repackage it. It shouldn’t be so successful, but it was sort of a breakthrough.
Before that we mostly treated the symptoms via pills or other methods, but that didn’t cure people… but talking did. We still have to learn a lot about the brain.
After that we shifted more and more from the pill treatment and more toward talking treatment… or talking treatment with something to support it.
This therapy is basically useful for every form of PTSD, but is significantly less effective, if the person has no or limited or tainted memory of the trauma or issue they are having.
Kind of the universal treatment, but not always the most effective one.
Cognitive Processing Therapy (CPT)
Second we got the Cognitive Processing Therapy or CPT, it is very similar to the CBT, we just talked about. But there are some key differences.
For me the most important difference is, that in this therapy it is more of a cooperation/teamwork/etc., where the patient isn’t reduced to a passive and responding position.
The second major difference is, that this method thinks the problem with PTSD stem from the old way of thinking (or the old you) is in conflict with the new way of thinking (or the new you).
A traumatic experience changes a lot of people drastically, sometimes even core aspects who they used to be. It is not called without reason a ‘life changing event’.
Some examples for this are your innocence or maybe trust in a person/institution/people/etc. or your whole life plan being thrown outside the window.
As this therapy is more of a cooperation, a part of the therapy is to provide the patient with information about PTSD, emotions, the method, etc. So the patient get access to the tools he needs for the therapy.
And third biggest difference is, that the person is supposed to write down what happened to him in detail and read it out loud in session and outside of it.
The therapist is supposed to help you then with logical errors and wrong thinking in the text, etc.
I think writing down the text is a great way to keep an overview of what happened, as it is easy to loose track. And if you try to keep it all in your head, it can be overwhelming and clocking your head.
I absolutely think it is crucial to give the patient information about his treatment, the illness and how emotions/trauma/etc. work.
The reading out loud part often even out of therapy is taken from the Prolonged Exposure Therapy, which is the next we discuss and I go in detail there regarding constant exposure.
But the reading out loud part can be an issue itself, as speaking or saying something make it become some truth, especially often repeated.
There is a good reason why for training and brain washing we let people constantly repeat what we want them to learn, because this way you kind of overwrite it into your brain.
You can use this technology in a positive way like with the mantra we talked about in Episode 4 - In case of an emergency.
If I ignore the reading out part, then I can recommend it to traumas, where there is a lot going on or where there was no way to keep overview of what exactly is happening.
Prolonged Exposure Therapy (PET)
In the third spot we have the Prolonged Exposure Therapy or PE or PET, which on one side aims for making you face the things you are avoiding, but also for the trauma itself.
And important part of this therapy is the teaching of what PTSD is, how the therapy works and breathing techniques, etc. to help you control the strong feelings.
You are supposed to make a list with avoiding behavior you are doing, so that you can either face them in reality (if safely possible) or imaginative.
This is the point where the therapy description splits. Some leave it there and other take it one step further: The patient is asked to talk about his traumatic experience, reliving it, which gets recorded.
The patient is then told to listen to his recordings daily or regularly. This way the symptoms are supposed to be reduced.
I have a lot of issues with this method and I will talk why in a second, but first let me focus on the positive: I think the list of avoiding behavior is an excellent idea.
This way you have it in black and white what you are avoiding and might find some hints about the trauma. I am also a fan of facing the situations you are avoiding out of fear — IF you removed the trigger first.
The assisted facing is a great security line, in case you are not as ready as you think or to have someone you can lean on, as it can still be very difficult.
Most sources, and I will line myself up with them, underlined the importance, that this makes sense, if the behavior is getting out of control and that normal avoiding behavior can be good.
As this is the brain trying to protect itself and if the brain is barely holding on, adding to that situation could be harmful up to destructive. The same as avoiding stairs with a hurt knee makes sense.
The aim should be to restore as much quality of life as possible. I do think one of the most important things it to face your PTSD, if you want to get cured. It won’t just go away.
Then there is the second part, which is my biggest gripe with this method: The constant exposure to the trauma to reduce the symptoms.
This is supposed to make the trauma less and less traumatic and reduce symptoms. But it just makes you the person numb, which is not really a good thing.
Imagine you are having an injury on your lower leg from a kick during a football game, what if in response to that the medic would keep hitting it until that part of leg goes numb?
This might be a crass example, but it underlines my issue with this method: This is not treating the illness it’s to desensitize the patient to the whole ordeal. Which might work for a while, but what then?
The trauma won’t go away like this, you just make it normal and I can tell you, that only lasts so long, before the issue returns. What is supposed to change this way?
I really can’t recommend it in any shape or form, on contrary I am shocked that some people think that this is a good idea.
Only referring to the second part of course. I think the first part is a great tool for helping you get back into life, dealing with the avoidance behavior and is a good way to improve your quality of life.
And this is where I am going to split this episode… might be better because I am really upset about the last method and I want to be fair and neutral to the other therapy forms.
I actually had heard of PET before, but had hoped, that I only misunderstood it, but nope. I understand that most of them most likely mean well, but this therapy should have stayed with phobia treatment.
It is hard for me calm down, after something that harms people. Especially since I know what it is like. Still I need to be more calm about this and I am curious what your experiences with those other methods were.
That was it for todays episode, I hoped I could give some clarity to some of the more commonly known therapy methods… well 3 of them. More come next week.
If you have any questions or feedback and the like, please let me know at firstname.lastname@example.org.
More information and transcript you can find as usually under johannadraconis.com/Podcast and links are in the description.
I hope to see you next time. Watch yourselves and have a wonderful time.