Academic journal article European Journal of Psychotraumatology

What I Have Changed My Mind about and Why

Academic journal article European Journal of Psychotraumatology

What I Have Changed My Mind about and Why

Article excerpt

Every so often, it is important to consider whether we are changing our views as we gather new information about treating trauma survivors with posttraumatic stress disorder (PTSD). In theory, the process of science should continually supply new information that changes our thinking. In practice, it is easy to view new data from the lens of existing paradigms and interpret findings as supportive of dearly held constructs and expedient hypotheses. Openness to new ideas requires courage and vigilance; it is, unfortunately, often the path to most resistance. However, failure to be open to change allows scientific observations to be hijacked in the service of reifying established ideas that have become comfortable, convenient, and even lucrative.

The field of PTSD is particularly vulnerable to ignoring inconvenient truths because it was conceived through grass roots activism, and breast-fed with political and social idealism. The goal of establishing the PTSD diagnosis in 1980 was to acknowledge the plight of victims of violence and tragedy. Data that subsequently would not have supported the construct of PTSD would have been socially and politically devastating since it would have called the diagnosis in question. Since the establishment of the diagnosis, there has been a dynamic tension between the need to support the foundational idea of traumarelated long-term effects, and learn things that might contextualize or even jeopardize this idea, so as to obtain real information that can be used to better understand PTSD pathophysiology and treatment (Yehuda & McFarlane, 1995).

Indeed, the past few decades have witnessed remarkable challenges to the PTSD construct. Epidemiological studies contested the notion that trauma exposure was unusual as previously thought, that PTSD was present in the majority who are exposed, that the etiology of PTSD is purely a result of stress exposure, and that its biology reflects a continuation of the normal stress response (Lehrner & Yehuda, 2014; Yehuda et al., 2015). None of those assumptions about the original diagnosis of PTSD turned out to be true, even though they served as the basis for the diagnosis (Yehuda & McFarlane, 1995). Interestingly, however, prevailing approaches to treatment still appear to focus on the centrality of trauma exposure. In this paper, a panel of experts were challenged to provide insights into how new data from research studies, as well as their own clinical experiences, have shaped their understanding of PTSD treatment, and brought new questions to the surface for future inquiry.

Dr. Yehuda opened the discussion by pointing out that confronting new truths occurs in the context of both structured research and clinical practice. The process of connecting with data, including anecdotes from patients, naturally leads to revisiting assumptions and formulating new hypotheses. Engagement in this iterative process creates new ideas and prevents old ones from stagnating. Dr. Yehuda encouraged the audience to be disrupters, disbelievers, skeptics, and revolutionaries. These are the required ingredients of change and will advance the field oftrauma and treatment oftrauma survivors more quickly than buy-in and dissemination of imperfect realities.

Professor Dr. David Spiegel

The first speaker on the panel was Dr. David Spiegel, Professor and Associate Chair of Psychiatry and Behavioral Sciences at Stanford University of Medicine. Dr. Spiegel was introduced as a visionary whose depth and breadth from clinical to biological research is far-reaching as a result of his pioneering work in the psychotherapy of cancer, and his ability to shed scientific light on commonly dismissed concepts such as hypnosis by subjecting these areas to rigorous biological study. Dr. Spiegel addressed two critical areas concerning limitations of treatment outcomes and methods in PTSD.

Dr. Spiegel began by stating that trauma is a spoiled identity. He explained that some aspects of traumatic stress and PTSD are just not fixable. …

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