Using logotherapy to treat PTSD

The next speaker I heard at the World Congress for logotherapy was Dr. Steven Southwick, who runs a clinical program for war veterans. Their rehab unit had people with severe PTSD.

PTSD affects a person’s world view, relationships, and everything in life. This unit was very chronic.

Their goal is to help the veterans put the pieces of the puzzle of their life together. They come in with symptoms they don’t understand. They come to understand that use of substance such as alcohol is a form of self medication for them.

The way the physiological system responds differently to stress becomes apparent when we see what happens to them. For example more adrenaline is released after a stressful event for these veterans than the amount released in a normal person. Other people in the veteran’s environment perceive this as overreacting. What is happening? They’re releasing more hormones in response to a stressor than the amount that would normally be released.

Alcohol is one of the three of the most powerful suppressants of hormones That’s why it’s not surprising that they take it. This is why we call it self-medication.
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By explaining this the veteran understands himself and the family understands him. This is helpful because before this they didn’t understand what was happening to them. We don’t want the person to feel he’s a loser. If they understand themselves they know it’s normal.

They are coming to us years later after the war and their life has already been effected in many ways.

Dr. Southwick went on to describe the logotherapy unit they started at the clinic and said it was surprising how vigorously the veterans engaged in it.

The first thing they said to the veterans was this: You are an expert. You are already experts in pain, trauma, being rejected by society, and so forth. Is there some way you can use your expertise?

Based on this expertise they gave the veterans community work to do.

In order to understand the work they are given we need to understand their trauma. PTSD is a profound type of fear conditioning. Whatever was present at the time of the trauma is part of it. There is a pairing of stimuli. For example if they go out on a hot muggy day this reminds them of a hot muggy day during their war experience and they will feel danger. There can be one, two or more cues. They can be conscious but a lot of it is not conscious.

Part of what they do in the clinic is to make it conscious so the veterans can do something when they’re faced with these triggers. This is part of putting the pieces of the puzzle of their life together.

Sometimes these people will avoid the store and all of the places that trigger them and lead very isolated lives.

In these kind of people the community service given to them to do was the task of helping shut-ins because the veterans understand them. This work is very rewarding for them. There is a big peer-to-peer program. Vets help run the homeless house. The clinicians were surprised to find how much the veterans wanted meaning.

In the clinic they also run discussion groups. If a participant makes some kind of statement such as: “It’s too late. My daughter hasn’t spoken to me in 20 years” They take that statement and put it to the group, and the clinicians don’t even have to say anything because the other vets chime in with “What do you mean it’s too late…?!”

Alternatively they’ll bring a quote from somewhere such as Helen Keller saying “Although I wanted to accomplish a great task…I realized I could accomplish something great with a small task…”

They tell them to contemplate on various quotes for five minutes and then ask: “What does this have to do with your life? The participants pick the most meaningful quote and discuss it.

For prevention they put themselves into a situation and imagine a meaningful thing at that time. (This utilizes the logotherapeutic technique of dereflection.)

They describe logotherapy to the participants as skill-development, not therapy. If they thought they were coming to therapy they would feel something is wrong with them.

They get the message: There’s nothing wrong with me. It’s normal for what happened to me.

Whenever an event makes you very happy, sad, angry or afraid you remember it. Strong emotions get locked into memory. This is how memory works. This allows me to focus on the most important thing in the situation and that aspect is what put it in our memory in a different way.

It takes hours for this process to consolidate the memory but if we cause something to interfere during this process, to shut out the memory, it won’t be consolidated as well.

The participants will for example run the marathon and thus replace stress with another stress. This enhances their self-esteem. They realize yes, I can handle stress.

Stress can be good. It is uncontrolled and unmanageable stress that’s bad. Chronic uncontrolled stress can damage a certain part of the brain.

Antidepressants and a supportive environment repairs neurons in the brain and allow the person to learn better.

Dr. Southwick then asked if any people in the audience had experience working with veterans. Some other people shared some points about the wonderful work they are doing as well. Unfortunately I did not take notes on it. If anyone reading this has something to share please send it to me at batya.yaniger@gmail.com and I will post it.

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