When Trauma Treatment Goes Out of the Box

Guest post by science writer Brenda Patoine

Yoga. Bodywork. Meditation. Chanting. Role playing. Tapping. Talking. These are all strategies used to try to heal psychological trauma, but only one of them (talk therapy) is backed by rigorous clinical studies of the sort that mainstream medicine deems acceptable–that is, randomized, blinded, controlled clinical trials that are published in peer-review medical journals. But does that mean the others are not useful?

As the largest clinical trial to date attempts to sort out which type of psychotherapy works best for which patients with Post-Traumatic Stress Disorder (PTSD), the debate over trauma treatment continues. On one side is most of the mainstream clinical psychology community, which looks at hard data and usually concludes that the only treatments proven effective so far are two types of talk therapy: Prolonged Exposure Therapy (PET), in which survivors repeatedly re-experience their traumatic event in safe environments, and Cognitive Processing Therapy (CPT), a talk therapy focused on challenging and modifying maladaptive beliefs related to the trauma. On the other side is a somewhat renegade group of therapists, counselors, and trauma specialists who are pushing the envelope and incorporating less rigorously studied alternative therapies into their treatment of trauma.

The debate burst into the public consciousness a few months ago when The New York Times ran an extensive article in its Sunday magazine–provocatively entitled “A Revolutionary Approach to Treating PTSD”–that touted out-of-the-box approaches to trauma treatment as championed by psychiatrist Bessel van der Kolk.

No stranger to controversial views, van der Kolk embraces the kinds of alternative therapies that most of the psychiatric community shuns, including yoga; psychomotor therapy, a role-playing therapy aimed at resolving the underlying psychological impact; and eye movement desensitization and reprocessing (EMDR), a treatment in which the patient follows the therapist’s hand motions across their field of vision while recalling the traumatic event. He is not a fan of cognitive behavioral therapies and openly derides PET and CPT as unhelpful and possibly damaging. “Trauma has nothing whatsoever to do with cognition,” van der Kolk says in the article.

Statements like that frustrate people who spend their lives treating trauma with cognitive behavioral therapies. Kathleen Chard, Ph.D., a psychologist and trauma recovery expert with the Cincinnati VA Medical Center who is co-leading the VA’s study comparing PET and CPT, expressed dismay at the unchallenged observations advocated in such a place as The New York Times Sunday Magazine, with its huge circulation.

“It’s disheartening when one article focuses on one person who says some very inappropriate things about how these treatments don’t work and don’t focus on the right things, when in fact the Institute of Medicine has found these treatments to be effective and the practice guidelines for the VA and Department of Defense as well as numerous randomized clinical trials in multiple different populations have found these to be effective.”

Calling it a missed opportunity to educate the public, Chard said: “There has been limited evidence to show that [these alternative therapies] actually decrease PTSD symptoms to the point of nondiagnosis. But what I find is that many people with PTSD have lost meaning in their lives and will grab onto anything that will give them a sense of belonging and a sense of value.”

It’s not that complementary strategies are not useful, Chard and others say; it’s that the kinds of rigorous studies that have shown psychotherapy to be effective have not yet been completed for these strategies. A number of studies are currently ongoing, including controlled, randomized studies assessing the effects of yoga, meditation, acupuncture and other alternative strategies in trauma victims in both military and civilian populations.

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