Treatment

1. ? Treatment Outcome …and then a miracle occurred... Healing Mechanisms in Critical Incidents & PTSD and the “Power Therapies”

2. This program was presented in symposium, “PTSD Institute,” at the 1999 St Louis County Human Service Conference, October 19-20, Duluth MN. The purpose of this slide series is to identify some of the mechanisms that contribute to the management of and recovery from PTSD, and to take a critical view of emerging therapies that do not subject themselves to conventional standards of inquiry or treatment efficacy. Questions and comments can be sent to David X. Swenson PhD LP DABPS at dswenson@css.edu

3. Healing Mechanisms in Critical Incident Intervention • Cultural • Preoccupation with and immediate service for trauma, emergency, • crises, violence • Belief that everyone deserves a good life (entitlement) • Belief in and need for quick fixes & immediacy • Social/Interpersonal • Immediate action communicates importance • Normalizing reduces isolation, broadens acceptance • Link with community & resource utilization • Confidentiality (trust & safety) • Protection • Cognitive • Engage cognitive skills to contain and channel emotions • Understanding process reduces fear of “going crazy” • Reframe experience as useful, survivor • Expectation of recovery • Reestablish a belief in control • Anticipate delayed reaction to minimize impact • Emotional • Discharge & reduce intense emotions • Emotional containment & stability • Safety, support, nurturance • Desensitization to cues • Physiological/neurological • Induce relaxation/self regulation • Decrease pain & anxiety • Lower ANS arousal • Minimize prefrontal-limbic disconnect

4. Pressures to Develop New Treatment Modalities • Cultural factors • Recognition of potentially lasting effects of trauma • Belief that everyone deserves a good life (entitlement) • Belief in and need for quick fixes & immediacy • Preoccupation with trauma, emergency, crises, violence • Widespread uncritical acceptance of Magical thinking, • paranormal phenomena, New Age, etc. • Managed Care • Competitive service environment • Generate revenues with high client loads and rapid • turnover • Cost-effective treatment • Reimbursement for some non-traditional methods • Client Factors • Pain, desperation, suffering • Requests for advertised/popular approaches • Low financial resources • Therapist factors • Good intentions to be effective • Power & control • Reputation as a specialist & “wizard”; “become the • Ultimate Therapist” • Faith in utility: Belief that “if it works” so what? • Extreme belief in constructed reality: “If you can think of it, • it’s real” • So long as it works it’s OK

5. Proliferation of “McTherapies” • Therapeutic Touch (TT): Delores Krieger’s nursing technique for healing by brushing & balancing your body’s energy fields (no touch) • Applied Kinesiology/Touch for Health (AK/TFH): George Goodheart’s chiropractic approach to acupressure • Thought Field Therapy (TFT): Roger Callahan’s algorithmic tapping to balance body energies • Emotional Freedom Techniques (EFT): Gary Craig’s modification of TFT • Tapas Acupressure Technique (TAT): Another modification of TFT by Tapas Fleming. • Miracle Acupressure Tapping Technique (MATT): more of the same • Energy Psychology (EP): still more by Fred Gallo. • Ear Tapping Desensitization & Remobilization (ETDR). Ear tapping. • Touch and Breathe (TAB). John Diepold’s combination of tapping and breathing technique • Limbic Emotional Release (LER). Joan Lonser’s method • Attractor Field Therapy (AFT): Acupressure to deal with universal energy fields that affect us • Acupressure Chakra Technique (ACT): acupressure combined with yogic energy centers • Creating, Allowing, Receiving Technique (CART): Tapping 1-2 meridians for the future • Be-Set-Free Fast (BSFF): Larry Nims’ four-step tapping algorithm to resolve unconscious energies • Eye-Movement Desensitization & reprocessing (EMDR): Shapiro’s Desensitization and resolution of trauma by thinking of the trauma while moving the eyes laterally • Neuro-Linguistic Programming (NLP): Changing our internal sensory representations of trauma

6. Conditions Treated by Energy Therapies: One size fits all? • Addictions (food, cigarettes, alcohol, drugs) • Allergies • Anxiety and Panic Attacks • Anger • Cancer • Compulsions & obsessions • Depression and sadness • Dyslexia • Eating disorders • Fears and phobias • Fibromyalgia • Grief and loss • Guilt • Immune deficiency problems • Insomnia • Migraine headache • Negative memories • Nightmares • Obsessive-compulsive disorders • Pain management • Peak performance • PTSD • Self image • Sexual abuse issues • Sexual problems

7. McTherapy Claims • Work rapidly, often within minutes; “instant relief” • Non-invasive, painless process with little or no • discussion of painful memories • Long lasting or permanent results • Results where others fail; 85%-99% success rate • Eliminates problems even when you don’t know • what the problems are • Dramatic testimonials • Based on centuries old traditional techniques of • healing, new discoveries in neurology or physics • One size fits all regardless of type of disorder • Simple, easy, painless, anyone can do it • Training available to anyone who wants to be a • healer; certification available

8. Alternate explanations to McTherapy cures: Likely but not fancy • Natural history and cyclicity of disease • Condition runs it course • Regression to the mean • Suggestion • Counter-irritation • Distraction • Audience demand characteristics • Hawthorne Effect • Stockholm Effect (please powerful figure) • Fatigue • Avoidance of painful memories • Habituation • Reinforcement • Desensitization • Placebo Effect

9. Problems with the Approaches Conceptual & Research Concerns • Demand characteristics of stage performance & Hawthorne Effect of studies • Few or no articles in peer reviewed, refereed, conventional, professional journals • Insufficient design controls • Unclear and insufficiently established diagnoses • Faulty logic & pseudoscientific comparisons • Reliance on self report rather than more objective measures • Unfounded transfer of concepts from physics to psychological & physical processes • Sale and use of quasi-scientific instruments at high prices • Diagnosis through unestablished procedures • Poorly defined and untestable concepts • Denial and rejection of established explanations • Nonfalsifiability of approach • Defiance and claimed irrelevance of established science procedures

10. Problems with McTherapy Approaches: Ethical Concerns • Professional ethics usually prescribe services that fall within conventional practice unless there is reason & evidence for diversion. • Although telecommunication treatment is not now unethical, it requires application of proper diagnostic procedures and sound basis for scientific and professional judgements. • Workshops and brief certification programs usually do not meet the requirements for competency standards for treatment. • Although testimonials are an accepted form of promotion, solicitation of testimonials can also present an unethical dual relationship. • Experimental forms of treatment require informing consent and keeping records on outcomes & followup. • Trauma increases vulnerability and susceptibility to direction and manipulation • Even if the methods do no direct harm, experimental approaches used may prevent the person from seeking more established treatment • Trauma often changes in world view, and unconventional therapies install an alternate view of reality.

11. Recommendations • Keep looking for innovations--better ways to • serve clients • When a novel approach is presented, ask: • How do you know it works? • What are the assumptions that underlie the • technique and how do you know they are • sound? • How do you know that some other • mechanism isn’t operating? • If you use these methods • make sure the client knows they are • experimental • keep good records • keep partialing out what the mechanism is • (use good science) • publish/share your results (+/-) • Challenge proliferation of unconventional • approaches without sound evidence