Researchers Liberzon and Abelson at the University of Michigan have published an essay articulating a new way of conceptualizing what is happening in the brains of those with Posttraumatic Stress Disorder. While you can’t read their essay for free, you can read this good summary here.
What is their new theory? the neurobiological problem of PTSD is “disrupted context processing.” In simple terms, I fail to respond to the “stimulus” in its proper context when I am triggered by old experiences in a new setting. Even more simply, when I wake up on full alert in the middle of the night after smelling wood-smoke in my sleep I initially fail to recognize the context (my neighbor burns wood) and immediately think my house is on fire (as it once was). Thankfully, the alertness is less than it used to be and I don’t always get up to check on my house.
The authors suggest that 3 separate and current brain models are inadequate in their scope of understanding the brain’s activities in PTSD. From their perspective the “fear model” (Fight/flight learning), the “overactive threat detection model” and the “executive functioning model” work best when integrated into one unified theory with their new label. And, in true humble researcher fashion, they request help in testing this model to see if indeed it can carry the freight.
An Old But Essential Treatment?
It is good to have a better handle on what is happening in the brain when someone experiences PTSD. Neurobiological research is growing by leaps and bounds. It is hard, frankly, to keep up. And yet, let us not forget an old but essential part of PTSD treatment, the person of the therapist. Humans are designed to be in relationship. PTSD has a way of shattering connections with others and thus the treatment must reverse the disconnect. Being present and bearing witness to trauma will always be the first and primary intervention every therapist must learn. Our temptation is that we want to move beyond the bearing witness phase into change phases. While this is understandable (we want others to get better as fast as possible), we sometimes want this for our own reasons–to avoid the pain we experience in sitting with traumatic experiences of others.
Let us remember that we therapists (and pastors, friends, etc.) are the primary intervention when we are present with those who suffer, when we become a student of their suffering. All other treatment activities stem from this foundation. To use a different analogy, consider Dr. Diane Langberg’s meditation, “Translators for God” (Day 26 of In our Lives First). In this meditation she describes the experience of being translated in a seminar. The translator must fully understand both languages in order to accurately communicate the speaker’s words into the heart language of the hearers. Counselors are translators for God and for healing. And yet, if they do not deeply learn the heart language (pain and trauma experience) of the client, they will not be able to connect the client to healing and to the God who heals.
6 responses to “PTSD: A New Theory? An Old Treatment”
Reblogged this on Finding Grace.
Phil – I’m not sure I understand the “bearing witness” part of primary intervention. Not that it isn’t a good idea, but as part of therapy. Can you expand?
Tom, the curative factors in therapy are centered on relationship, alliance, and trust and these seem to be even more important than theoretical model the clinician endorses. This is not to say that therapy is not anything more than being a good listener and kind. However, if it doesn’t start with bearing witness to their traumatic experiences, listening, being present in their pain, then nothing else will happen.
If “bearing witness” means listening and being present in pain…ok. I just think of BW as a public act, as in advocacy and seeking justice. But, is that where you’re going with this?.
Bearing witness takes many forms. Elie Wiesel bears witness to the holocaust. Attending the funeral of a loved one is a form of bearing witness. These are more public forms that may have advocacy. Bearing witness also happens in therapy as well. We are being willing to enter in to someone’s distress, we are willing to know deeply. This activity is well-known to be one of the common curative factors across all therapy models.
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