PTSD counselling : talk therapy not best approach.

There are many forms of PTSD counselling, many cognitive rather than experiential. It has been known for over a decade now, that adults with a history of trauma and symptoms of Posttraumatic Stress Disorder (PTSD) have a decreased volume of the hippocampus, the part of the brain that is shaped like a sea-horse at the base of the skull which is responsible for integrating cognition and sensory/motor information from experience. This part of the brain also has connections to the prefrontal cortex of the brain which is involved in decision making and executive functions. Damage to the hippocampus leads to fragmentation of memory, so that “declarative memory” fails to store in the prefrontal cortex.  We do not yet know for sure whether trauma is the cause of a reduced hippocampus or is the consequence of it. However, research seems to suggest it is the cause[1].

Declarative memory is the type of memory that can be consciously recalled and is also known as explicit memory, which is memory of facts and knowledge, such as learned facts (semantic) and what happened (episodic), as opposed to procedural memory, which is more unconsciously recalled, such as skills, as in how to ride a bicycle. In PTSD sufferers, both memory storage and retrieval are affected. Using brain function scans, PTSD sufferers are found to have the limbic system and visual cortex activated but not the prefrontal cortex and left hemisphere speech areas, as in non-traumatised people’s memory recall. Memories for trauma, therefore, are stored in non-verbal ways and recalled as feelings and sensations, not as a verbal narrative[2].

In counselling, for PTSD symptoms to be relieved, the “trauma narrative” needs to be processed. If, however, trauma memory recall is non-verbal, then “talk therapy” alone may not be sufficient in retrieving, reprocessing and giving new meanings and understanding to traumatic events, so that current symptoms can be alleviated. When survivors of trauma are exposed to certain cues, sometimes those repressed memories surface. This is known as delayed recall.

Engaging thoughts, feelings, sounds, smells, body sensations and all experiences of the traumatic event is therefore, of utmost importance, if trauma sufferers are to be helped. This is the rationale behind Inner Change Therapy.

Do you have an experience of therapy (either good or bad, helpful or not helpful) to share? Leave a comment below. (Your contact details will not be shared).

[1] Bremner, J.D. (2008). Hippocampus. In   Reyes, G., Elhai, J.D., Ford, J.D. (Eds). The encyclopedia of psychological trauma.  pp.313-315. Hoboken, N.J.: John Wiley & Sons.

[2] Brown, L.S. (2002). Chapter 1: The recovered memory debate: where do we stand now? In Zeig, J.K. (Ed). Brief therapy: lasting impressions. Phoenix, AR: The Milton H. Erickson Foundation Press.


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