Return from Chaos: Treating PTSD | Peter Tuerk | TEDxCharleston

Return from Chaos: Treating PTSD | Peter Tuerk | TEDxCharleston

[Music] now most everybody’s heard of post-traumatic stress disorder or PTSD but the disorder is not well understood by our culture our media and by many in the medical professions I think perhaps it’s because the name has the word stress in it so it’s logical to assume that whenever people are having a hard time adjusting to a series of stressful or trauma life-changing events that they might have the disorder but the disorder is much more specific than that traditionally it’s thought of being comprised of at least three components reexperiencing symptoms arousal and avoidance typically people get reexperiencing symptoms in the form of vivid intrusive memories and Nightmares of the traumatic event this in turn leads to immediate physiological and emotional arousal which leads to immediate avoidance people push the memories away actively and avoid situ sitations that remind them of how they felt doing the event now this avoidance is absolutely understandable but it prevents the event from being processed and put away so it’s kind of like having a sock sticking out of a drawer The Memory Remains easily accessible and CED up at times when perhaps it shouldn’t be and having this traumatic memory always in the queue makes it difficult for people to feel safe in almost any situation over time their beliefs and behaviors change to match how they feel so why do we get PTSD symptoms there’s very many of them and researchers debate and argue over the roles of them but reexperiencing symptoms are the only that are unique to the disorder so they can give us Clues into the nature of it so why do we get these symptoms while a leading theory developed at the University of Pennsylvania suggests we get these symptoms because our bodies indeed our human condition has an experience and a gravity to process emotional information and when we came our body doesn’t know what to do with the information so it keeps it on Loop right so what do I mean by gravity to process well let’s consider the evolution of the shark we’re told that this is Nature’s perfect swimming and eating machine in fact it’s such a perfect machine at doing these things that if you try to stop a shark from swimming there’ll be dire Health consequences for the shark well much like the shark who needs to swim to be healthy we need to process emotional information it’s what we do nature is adapting us to be Keen organizers of incoming information with one-time trial learning amazing abilities of pattern recognition and the ability to create schemas or internal file folders that guide our behaviors and organize new situations right all of these amazingly evolved capacities are all focused on giving us an ability to instantaneously stamp and recall emotional content related to incoming information we need to do this first because we have to know whether or not to be afraid of something it’s the evolutionary pressure to keep us safe so we can reproduce now safety depends on predictability and predictability depends on conquering chaos wherever it’s encountered and our brains are physically arranged to facilitate this immediately as a result humans aren’t very capable of experiencing chaos we use the word Loosely to describe disorganized situations but true chaos is beyond description to us it’s almost as if we’ve been involved not to touch it art can help us understand this consider this artistic rendition of chaos well almost immediately you’ve already processed and organized what’s going on in this Photograph it’s interesting but it doesn’t really challenge our core experience of order in the world and all art that tries to get us to experience chaos is going to hit the same barrier the audience us humans we’re just too good at processing information we have a gravity to process and we do it very quickly so again what exactly am I talking about with all this gravy to process stuff everybody listening to this talk can understand in their bones what I’m referring to imagine you’re going to walk into this Quicky Mar to get some milk you have an internal file folder for what this experience is all about you know the milk’s going to be in the back and a glass cabinet there might be a bubble mirror to stop you from stealing right and you hope you’re not behind somebody’s getting lottery tickets we know exactly what this is and the more the event matches our internal file folder the less memorable it is montho go by and you won’t even remember that Thursday when you got milk and I think we all should agree on this but now let’s say you walk in here and you see something completely weird like a clown juggling well immediately without you wanting to deciding to or maybe even being aware you start flipping through probabilities of why this clown is here and looking around for Clues to sort it out I want to invite everybody to appreciate that it would take an extraordinary human being to see the clown and not try to figure out why is he here right that’s our gravity to process but now let’s say you walk in this Quicky Mart and there’s an elephant in the back and it’s mayem he’s taken up five or six rows there’s mouths of Ho Hos and Twinkies you make your way over everything and get your milk and ask the cashier hey man what’s up with this elephant the cashier’s no help he says I don’t know well now we have a very difficult situation to process and I think we all can agree that it’s going to stick out next time we see an elephant or any zoo animal we’re going to think of this quick Mar now the very important difference between this elephant example and something that can cause PTSD is that the elephant doesn’t carry with it the intense emotions associated with the life-threatening event so we don’t avoid thinking about it in fact the opposite happens right you’re going to tell everybody you know about this elephant you’re going to be on Facebook with the the elephant we’re going to be able to see selfies of you and the Elephant online right and as a result you’re going to process this event and it’s likely to go into a folder that says some version of crazy things happen in the world and I don’t know why and as we get older that folder gets larger and larger right it’s one of the reasons why we don’t get PTSD from Simply perplexing events so you see in PTSD it’s not necessarily that the event was so stressful it’s that the event is so emotionally different from anything we’ve experienced that we don’t have a file folder and the associated feelings are so intense that it prevents us from making one even though it’s well with our capacities to do so in truth it’s probably the case that only life-threatening events are strong enough to get us to experience something emotionally that’s brand new but without that experiential file folder it’s as if all the assumptions we rely on Fall Away during the moment of the trauma and we’re face to face with sheer unmediated experience or chaos it’s one of the things we’ve been involved not to touch and like antimatter touches matter and annihilates it this little bit of unprocessed chaos bouncing around in US destroys or seriously undermines our natural and necessary assumptions about the way the world works and who we are in it now luckily this is a highly treatable condition if avoidance is preventing natural recovery as the theory tells us we need to not avoid exposure therapy gives people the opportunity in a safe supportive and expert environment to approach their traumatic memories and avoided situations for a long enough period of time for the Hot Potato to cool now once this potato cools and it’s not associated with immediate intense reactions you can pick it up examine it make a folder and put it away right now it’s important to note that traumatic memories are never going to be positive but approaching this memory repeatedly until it loses its power gives people control over the memory and more importantly it allows them not to be controlled by the constant fear of having to avoid triggers such as certain television shows watching the news or being in crowded public events like Ted Talks so one of the things that I’m wonderfully blessed to be part of is treating veterans that come back from combat with post-traumatic stress disorder and it is an amazing thing to see people with the courage to confront and practice their way out of PTSD much of my research involves investigating the leading form of this treatment called prolonged exposure therapy and running clinical trials to try to improve it and looking at nonprofit ways to disseminate it more broadly and I’m lucky enough to be part of a very Progressive VA sponsored initiative to spread the treatment throughout the system with some amazingly talented people and prolonged exposure therapy we help folks sort through their most traumatic memories to focus in on the ones that are causing the most symptoms once we have those focused in on we train them in proven methods how to sit with the memory for a long enough period of time much longer than they’re used to doing now folks with PTSD always have these memories popping up but remember they push them away immediately so the idea of sitting with a memory on purpose for 30 or 40 minutes at a time is something completely new it’s one of the reasons why the treatment can be so effective and we know it’s effective because throughout the process we’re asking people about their distress levels and those typically go way down now part of my research involves making that process more meaningful for everybody involved through objective physiological Wireless assessments and the use of mobile applications that can be widely disseminated for free so for example a veteran can come in and start the process of confronting a traumatic memory and at first physiological responses can be quite High not dangerously high but very uncomfortable but he sticks with it and next week comes in and it’s a little bit lower and then lower having visual proof of getting better is wonderful positive reinforcement for engaging in a treatment that’s difficult yet highly effective imagine how much more motivated you might be for weekly chemotherapy sessions if you could see your cancer diminishing with each dose and positive reinforcement is important because mental health treatments only work if people choose to complete them now most people who start this process do complete it because they’re tired of having PTSD and want to do something to get rid of their symptoms not learn how to cope with or live with their symptoms but learn how to live without them and that happens every day prolonged exposure therapy is not new or experimental it’s been around for 25 years and it is the most well researched effective and validated treatment for PTSD on the planet one of the things I’d like you to take from it is that all of this research lets us know that the treatment works across a wide variety of traumatic spectrums and also across a wide variety of individuals such as First Responders those with PTSD and traumatic brain injury substance use issues depression and in geriatric and pediatric populations and also for people living in highly rural or isolated areas over tele Health technology as some of my research has suggested now no treatment is 100% effective all the time and it’s very important that we appreciate that sometimes PTSD is just one of the negative consequences of trauma and so treating it doesn’t necessarily mean that people won’t require extra help even so the vast majority of people who complete prolonged exposure therapy experience significant symptom reduction and many experience complete remission altogether as demonstrated by clinical trials and Clinics all over the world so we have a treatment we know works and all major mental health guidelines suggest it uses the Frontline treatment for PTSD yet it is not widely available at all points of care so we have a lot of work to do and we can’t do it alone in PTSD there’s a lot of media buzz noise and lack of consistent messaging from providers it makes it difficult for consumers and Healthcare managers to appreciate the difference between scientifically proven treatments to eliminate symptoms from treatments designed to help people cope so help us spread the word that PTSD is a highly treatable condition and the prolonged exposure therapy you can be the first stop on the road to recovery now knowledge impacts expectations and my hope is that you know enough to expect your life back thank you [Applause]

Peter Tuerk, the director of a VA PTSD program, introduces how we process experiences and trauma. Using examples from his research, he describes how it’s possible to process memories and their associated meanings to overcome a traumatic incident. When active avoidance impedes natural recovery the most effective healing is facilitated through treatment designed to limit avoidance and to assist with the processing of relevant information.

Peter Tuerk is the section chief of the PTSD Clinical Team at the VA in Charleston, South Carolina and Associate Professor of Psychiatry at the Medical University of South Carolina. His clinical research and training focuses on the treatment of combat-related PTSD in the areas of therapy effectiveness, treatment enhancement and dissemination, as well as telehealth and applied technologies. The author of 40 publications regarding the integration of technology into treatment, Dr. Tuerk has made numerous presentations, in the U.S. and internationally. What he has learned and developed through the VA, he has transformed to share with others. Dr. Tuerk founded the Japanese/U.S. Evidence-based Mental Health Response Initiative (JEMRI), a non-profit organization that supports the dissemination of effective PTSD treatment for people who have experienced natural disasters. youtube.com/user/PeterTuerksChannel

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx