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What new non-drug approaches to treating PTSD are on the horizon?

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My husband purchased a virtual reality headset a couple of years ago to enhance his workout routine. I thought whatever supports his efforts to maintain his health and increase his chances of a longer life, go for it! Two years later, he continues to use it, so I’m grateful it was not just another impulse purchase that sits on a shelf somewhere. His continued use of it reflects virtual reality’s potential staying power. What does any of this have to do with PTSD treatment?

One of the first-line evidence-based treatments for PTSD is prolonged exposure therapy. Prolonged exposure is a trauma-focused psychotherapy that supports people as they confront memories, feelings, and situations that they avoid since their trauma. The premise of this approach is to gradually teach them that their trauma-related memories and cues are no long dangerous in the present and don’t need to be avoided. One approach to prolonged exposure is imaginal exposure where the person revisits the traumatic memory in their imagination and recounts the event. This imaginal exposure causes the person a great deal of distress, promoting emotional engagement with the trauma memory. It is then followed by cognitive processing of the experience of revisiting their trauma. Although effective, might there be another approach that might reduce the level of distress by speeding up the psychophysiological habituation process through this approach?

That is the exact question that the VA attempted to answer in a recent research study. They wondered if they added repeated, bifrontal direct neurofeedback (AKA transcranial direct stimulation) to therapeutic exposure using virtual reality, would it reduce the symptoms of PTSD perhaps faster. The VA already recognized the significant potential of noninvasive brain stimulation as a novel treatment to reduce PTSD symptoms, specifically in the particularly difficult population of military veterans. They had conducted a prior pilot study that showed promising findings which prompted them to move forward with the gold standard of research, a double-blind randomized clinical trial. This RCT replicated the key findings of the pilot study, including significant improvements in self-reported PTSD symptoms, reductions in autonomic arousal, and improvements in their social functioning. They concluded that combining repeated direct neurofeedback with virtual reality is a promising strategy and highlights the innovative potential for these combined technologies.

If you are interested in reading the full research article, click below:

Neurofeedback and Virtual Reality for PTSD

What is shame and why might it be important to talk about it?

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I imagine we all can identify something that we experienced in the past that we feel ashamed of. I know I can. I can also imagine that most of us simply try to ignore any memories of that experience, to avoid the uncomfortable emotions it might bring up for us. Unfortunately, shame is like toxic mold. It doesn’t go away unless you shine a light on it and let the air hit it.

 Shame is complex. It is an emotion that includes feelings of unworthiness, inadequacy, and/or embarrassment about yourself. It is different than guilt. Guilt arises in response to specific actions or behaviors and we think “I did something wrong”. Guilt comes in service to guide us back to acting in ways that align with our core values that make up our authentic self. Shame, on the other hand, arises in response to a perceived personal failure or shortcoming and we think “I am wrong or bad” about ourselves.

 It is important to understand that when we experience shame, we tend to internalize it, which leads to negative self-beliefs and self-criticism. Shame affects our self-esteem and contributes to mental health issues, like anxiety, depression and post traumatic stress disorder (PTSD). It can be heavily influenced by our social and cultural contexts, such as societal expectations, family dynamics, and cultural norms. For example, cultural standards about appearance, success, or gender roles might evoke feelings of shame if we don’t conform to such standards.

 When we experience those powerful and uncomfortable feelings of shame, which activate the thoughts around our inherent unworthiness or inadequacy, we tend to turn towards potentially unhealthy coping strategies to deny, distract from, cover up or numb those emotions. We might also experience a desire to withdraw or isolate ourselves from others. These behavioral responses are natural adaptive responses, yet such behaviors can lead to physical and mental health challenges. In fact, research has shown that trauma-related shame is connected to the development and maintenance of PTSD.

 Understanding that shame is a common experience for us humans is a first step toward releasing its grip. Recognizing how social and cultural messages can contribute to the creation of shame is also important. Unfortunately, this awareness and understanding is often not enough to kill that toxic mold that lives in the dark recesses of our minds and bodies. Addressing shame often involves identifying and working through deep-seated feelings and challenging the negative self-beliefs that grew from the toxic mold.

 There is a growing body of research that suggests not only can talk therapy help in understanding the roots of our shame but developing the skill of self compassion can reduce those powerful and uncomfortable feelings that have us thinking we are inherently bad or flawed. One recent proof-of-concept study combined cognitive techniques with loving-kindness meditations to specifically target shame in trauma-exposed patients. The findings supported positive outcomes and led to reductions in trauma-related shame and PTSD symptoms.

Loving Kindness Meditation to Reduce Shame