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One study published in the American Psychiatric Association found that "PTSD has been shown to predict poor health not only in veterans of the 1991 Gulf War but also in veterans of World War II and the Korean War. Our study extends these findings in a group of active duty soldiers returning from recent combat deployment to Iraq, confirming the strong association between PTSD and the indicators of physical health independent of physical injury" (Hoge, Terhakopian, Castro, Messer & Engel, 2007). From this study one can certainly glean that PTSD has a somatic component to it, or at least there is a prevalence in which persons afflicted with PTSD also suffer from physical health problems. One can also assume that the somatic component was downplayed or overlooked in prior studies, as most treatments for PTSD do not seem to address the physical aspect of the disorder.
To elaborate on this assumption one should consider CBT, as mentioned, one of the most researched and most studied treatments for PTSD. To provide a little more clarification on what CBT is, it's an integrated approach that blends cognitive therapy, therapy that address the thoughts that produce and lead to maladaptive behaviors with behavioral therapy, therapy that focuses on curbing behavior (Gelso & Fretz, 2001). In a study conducted to find out how effective multiple-session psychological interventions were at preventing and treating traumatic related stress symptoms shortly after the event had occurred (within 3 months), the researches found that "Trauma-focused CBT was the only early intervention with convincing evidence of efficacy in reducing and preventing traumatic stress symptoms, but only for symptomatic individuals and particularly for those who met the diagnostic criteria for acute stress disorder or acute PTSD" (Roberts, Kitchiner, Kenardy & Bisson, 2009). In other words, despite all the other intervention techniques that were tested and analyzed in this study, only CBT was effective at mitigating stress symptoms for individuals who had manifested symptoms of PTSD and those, in a particular subset, suffering from acute PTSD. Although this may sound like CBT is a formidable treatment against PTSD, it is really not maximally effective as an early-intervention treatment (especially for those who are asymptomatic and who fall outside that subset). But to be honest, there are no real known cures for PTSD or early interventions that will completely eradicate (latent) symptoms.
This study concludes by stating this, "Given the modest overall effects of trauma-focused CBT, the development and trialing of other psychological treatments are important" (Roberts, Kitchiner, Kenardy, & Bisson, 2009). Although the orthodox approach of CBT is modestly effective, more research is surely needed. Psychologists have miles to go before they sleep with regards to finding a super effective treatment for PTSD.
With that said and to address what I alluded to earlier, there are other unorthodox treatments that show signs of promise. One pilot study published by The Journal of Nervous and Mental Disease in 2007 found that acupuncture might help mitigate symptoms of PTSD. Of the 73 people diagnosed with PTSD and examined in the study, those who received acupuncture treatment and those in a separate group who were part of group-CBT treatment both achieved similar results that faired better than the control group (Hollifield, Sinclair-Lian, Warner, Hammerschlag, 2007).
What's interesting about this study is the fact that a treatment methodology was used (acupuncture) that addressed the patient's body. As mentioned above, most treatments (including trauma-focused CBT) neglect a tactile, literal "hands on" approach. Before one jumps to conclusions, I should acknowledge that the findings in the acupuncture study are tenuous. For starters it was a small sample size, it was a pilot study, and acupuncture -- as many practitoners of acupuncture hate to admit -- is not grounded in empirical science or biology. Nevertheless the proposition of combining and integrating trauma-focused CBT with acupuncture and other forms of physical treatment (exercise, running, etc.) is an enticing one. More research needs to be conducted to determine how this two-pronged treatment approach (CBT and physical techniques) can work to maximize PTSD treatment efficacy.
This is the stuff that keeps me up at night, trying to devise new and more effective ways of addressing old problems. Even during my first placement, I might have been a little to eager to suggest unconventional approaches to helping my clients. Again, "unconventional" in the sense that I tend to approach things from a macro-position -- body, mind, and spirit. Conventional wisdom is that psychology and therapy are disciplines only reserved for the mind. I disagree. I think that is a narrow way of looking at human beings. I believe that everything is connected. However, I am also keenly aware of how thinking along these lines can be troublesome as I continue my journey.
I suppose this is where gaps exist in my education. I'm I still awaiting a life-alter disillusionment that fundamentally changes the way I think? Maybe. As the controversial figure Donald Rumsfeld once said, "there are knowns, known unknowns, and unknown unknowns" (Press Conference, 2002). So if I had to do a quick breakdown of what I know, what I know I don't know, and what unknown unknowns lie ahead, I would suggest that a life-altering disillusionment that fundamental changes the way I think would probably fit into that last category. However, as logic permits, I can at least remark on the first two. For example, I know or I think I know (this can easily devolve into a whole intellectually nihilistic discussion over what I think I know vs. what I actually know, which, of course, begs the question of "what can I really know about anything?") many of the fundamental precepts of the aforementioned therapies such as CBT, PCT, etc. I know that therapy works (Cooper, 2008). Although, to varying degrees, which are contingent upon varying factors: client-therapist relations, style of therapy used, and most importantly client factors, i.e. does the client believe that what he/she is doing will help him/her (Cooper, 2008). What I don't know, but need to know is will my heavy-handed theoretical background translate into quality therapy? In short, will all this stuff I learned make me a good counselor/therapist? My first placement went well, but it was limited in many ways. I facilitated the support for those two ladies. And I times, I did employ some fundamental interventions. But, I still have yet to really spread my wings to see if I can actually fly, and fly well. This, though, will come in due time.
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