HEW research

[Eric Rutberg]

Hi all, 

I am following this discussion with great interest. The following is an excerpt from an article I am seeking to get published. I think it pertains to this discussion. I welcome your feedback !

The Psychobiology of Treatment
 
Informed by a wealth of knowledge about the psychobiology of PTSD, the implications for role-play as a form of exposure therapy become better defined. van der Kolk (2006) proposes one may unlearn previous conditioning by revisiting situations that were previously fear provoking, and act upon the stimulus they fear. Currently, Madigan Army Medical Center is in the process of fine-tuning a new therapy for combat-related PTSD that involves recreating the sites, smells, sounds, and feel of Iraq with the use of a virtual reality helmet. “The new technology provides a tool for veterans to vividly, yet safely, confront war experiences and allow reintegration of the parts of the self that were unable to tolerate the trauma when it originally occurred” (Paquette, 2007, para. 3). While virtual reality therapy is being fine-tuned and likely unavailable to most, role-play can be an effective tool for engaging imagination in a way not dissimilar to that of
 virtual reality technology. 
Our inner world is like a virtual reality and action methods enable us to externalize or project this virtual reality into the room where we are working. Senses are the gateways through which we take in all the information that is processed by the brain/body system. Dayton (2006) explains, the more senses involved in an experience, the more the brain will remember the experience. Role-play allows the repeated and powerful pairing of the fear-producing situation with a positive experience of improved management of somatic sensations, validation, support and essentially, the creation of an alternate memory that brings open-ended tensions to a close. 
The Biology of PTSD: Using role-play, clinicians may address trauma at a biological level by “eliciting the release of endogenous, stress-responsive neurohormones, such as cortisol, epinephrine and norepinephrine (NE), oxytocin and endogenous opioids” (van der Kolk, 1994, p. 3). The counselor then “assists clients in focusing on the regulation of affective states and the experience of intense emotion” (Fosha, 2003, p. 9). To best understand the workings of exposure therapy, one must be versed in the biological underpinnings of PTSD. PTSD is the result of repeated, autonomic misinterpretations of current events with disturbing psychological and somatic symptoms ensuing. Specific symptoms can be correlated to the release of certain neurohormones or a combination thereof. For instance, norepinephrine is an activating agent, responsible for initiating fight, flight or freeze behaviors while “cortisol, allows a person to think clearly in the midst
 of a triggered fight, flight or freeze response” (Sturgeon, 1999, pt. 2). Sturgeon (1999) cites studies that show the hypothalamic-pituitary-adrenal (HPA) axis may be conditioned to release lower levels of cortisol in those who experience a traumatic event. While more research is needed, the result of reduced cortisol production and the conditioning of the HPA axis, in cases of repeated trauma, is a likely explanation for the increased feelings of anxiety in patients with PTSD. 
Post-traumatic symptoms such as physical and psychic numbing, fragmented memories and dissociation may well be correlated to the conditioned release of endogenous opioids dispatched to defend against perceived or real emotional or physical pain. This powerful biological reaction occurs at the time of the original traumatic event, as well as each time the feared memories are triggered. Each time these responses misfire, the conditioned response becomes ever more engrained. 
The Psychology of PTSD: In addition to the mechanical release of neurohormones, “alterations in memory form an important part of the clinical presentation of patients with PTSD” (Bremner, 1999/2002,para. 5). Beyond the reconditioning of an individual's response to anxiety provoking stimuli, role-play may directly impact the way one remembers the past trauma. Various aspects of memory are processed by different brain structures. “Factual memory mainly involves thehippocampal formation whereas the emotional component of learning involves the amygdaloidcomplex” (Desmedt, Garcia, & Jaffard, 1998, p. 1). “The architecture of the brain gives the amygdala the priviledged position as an emotional sentinel” (Goleman, 1995, p. 17), allowing quick response in an emergency. “For individuals diagnosed with PTSD the hippocampus and amygdala malfunctions which result in the distortion and fragmentation of memories, dissociation and even amnesia”
 (Departments, 2002, p. 1). 
            Role-play “gives us the opportunity to suspend (trauma) in time, allowing one to study a memory in its concrete form” (Dayton, 1994, p. 3). Guided by a clinician, role-play offers an experience that engages the many senses, so one can recall memories at the somatic level, as well as the opportunity to process the scene on a cognitive level, In their article, Nijenhuis, van der Hart and Steele (2004) report patients with PTSD often present with cognitive distortions resulting from an inability to integrate the facts and implications of a traumatic event. Role-play facilitates the recall of memories, emotions or thoughts and integrates them into ones personal, current-day narrative. As such, memory becomes as much an act of creation as a vestibule for trauma.  




________________________________
From: T. Treadwell <ttreadwe at grouptalkweb.org>
To: Jenny Wilson <jenny at blennerhassett.gen.nz>
Cc: "list at grouptalkweb.org" <list at grouptalkweb.org>
Sent: Sun, March 28, 2010 9:25:31 PM
Subject: Re: HEW research

ron and jenny
Have not heard of the research you mentioned.  However, you might want to
look at this article...it may be the one ?

Kipper, David A. & Ritchie, T. D. (2003). The effectiveness of
psychodramatic techniques: A meta-analysis. Group Dynamics: Theory,
Research and Practice, 7, 13-25.

Tom


> Hi Ron
>
> I have been keeping an eye out for research comparing or combining CBT
> and Psychodrama for the last year or two (and have searched for these
> articles on good search engines and databases). I have not seen the
> research you mention and am really keen to hear about it if someone has
> a reference. I guess it may not be specifically about psychodrama but
> more about experiential methods in general. There is a good recent
> review article supporting the efficacy of experiential therapy methods
> in general but not comparing it with CBT- I will post the reference once
> I find it.
>
> What is HEW by the way?
>
> There are two papers by Hamanci that may be of interest. The 2006
> research has results that suggest that psychodrama enhances the
> effectiveness of CBT by increasing motivation and may help prevent
> relapse.
>
>> Hamamci, Z (2002) The effect of integrating psychodrama and cognitive
>> behaviour therapy on reducing cognitive distortions in interpersonal
>> relationships. Journal of Group Psychotherapy, Psychodrama & Sociometry,
>> Spring, 3 -14.
>> Hamamci, Z. (2006) Integrating psychodrama and cognitive behavioural
>> therapy to treat moderate depression. The Arts in Psychotherapy, 33,
>> 199-207.
>
> Regards
> Jenny
>
>
>
> Ronald Anderson wrote:
>> Arlene Story, TEP, when speaking with my students 5 or 6 years ago, said
>> that while doing graduate work, she had come across a research project
>> from HEW comparing the outcome of experiential methods compared to more
>> cognitive/behavioral approaches, with preliminary conclusions that using
>> experiential methods had more efficacy, with more long-lasting
>> results.    In asking Arlene about where she found that research, as I
>> couldn't find it online, she protested that when she had just moved to
>> Florida, to become clinical director at The Refuge, it was somewhere
>> hidden in boxes she hadn't gotten around to go through yet.
>>
>> Is anyone else in our group aware of such a government-sponsored
>> research project, and where to get hold of it?
>>
>> Appreciate.
>>
>> Ron Anderson
>>
>>
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Thomas Treadwell        CompSoc - GraphPlot              Computerized
Dept. of Psychology            \ /                        Sociometry
West Chester Univ.            __/ \__                  Phone-610-436-2723
West Chester, Pa.    ttreadwe at grouptalkweb.org        FAX-610-436-2846
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