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part 1
PTSD and time perspective therapy
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Chapter 1
how PTSD sufferers get stuck in time
At age forty-five, Kara's life was full. She and her husband, Bud, had been married for twenty years. They'd decided early on that they would forego having children to focus on their relationship and have fun together, and they had done just that. They loved Alaska's outdoor lifeāriding motorcycles, deep sea fishing, camping, and hunting. Kara's job with the highways division of the State of Alaska Department of Transportation was fine too. She drove a pickup truck and hauled a light board signaling traffic to change lanes for the highway work crews. It was a good job, and it let her have the life she wantedāuntil one day a young woman driving a large pickup truck came speeding down the road and smashed into Kara's truck, catapulting it into the air where it flipped over, came crashing down, and landed on its roof with a scream of broken glass and metal on asphalt. Kara's coworkers dropped everything and rushed to help.
They found her trapped inside, hanging upside down, suspended by her seat belt, injured but alive. For Kara, everything was happening at once. She was in shock. She knew that her head, neck, shoulder, and back had been injured. She wanted to get out. And she was desperate to know what had happened to the driver of the vehicle that hit her. Her coworkers, concerned for their friend's life, told her not to worry about the other driver and not to move until the paramedics arrived.
But Kara could smell gas and feared that her truck might explode. Frantic, she tried to release her seat belt. It was jammed. And even if they had tried to, her coworkers would not have been able to help her out of the truckāit had been so flattened by the impact that there was no way for them to get to her. With the clarity that comes with shock, Kara saw that if she could get loose she could find a way out. So she reached into her pocket, found her pocket knife, and cut through the seat belt, falling abruptly and landing on her already injured head, neck, and shoulder.
Kara crawled out of her truck and tried to head toward the other pickup. Despite her many injuries, and even though her coworkers were physically restraining her, she was extremely anxious about the other driver and managed to force her way through the crowd, only to witness the young woman's last moments of life. Strewn all over the back of the cab were signs of family lifeāan infant car seat, a diaper bag, and baby clothes. But there was no infant, and a search failed to turn up anything. Kara later discovered that the woman who hit her was the mother of a toddler, who thankfully had not been in the vehicle at the time of the crash. But Kara was devastated to discover that the young mother had also been pregnant.
The accident changed Kara's life. She had sustained injuries to her skull, neck, spine, shoulder, abdomen, and knees, and underwent a series of operations and procedures to repair the damage. Physically, she was slowly improving; but the psychological damage was severe and more enduring. She began psychotherapy, including psychiatric and psychological treatment.
Four months into Kara's psychotherapy, Kara's psychologist was worried. Psychological testing confirmed extreme trauma, extreme depression, extreme anxiety, and panic attacks. Kara had severe post-traumatic stress disorder. And now it was the dead of the brutal Alaskan winter. With almost no hours of sunshine, it seemed impossible that Kara would ever be able to conceive of a world without darkness, both external and internal. Her psychologist thought that a change of scenery to a warmer, sunnier climate might at least helpāa lot of Alaskans escaped the winter by flying to Hawaii. Kara's workers' comp adjuster agreed. The psychologist did her homework, and discovered that on the island of Maui a psychologist named Richard Sword was practicing a new therapy that appeared to offer tremendous results for people like Kara.
Kara and Bud spent their first day in Maui settling into an ocean-side condo, and then got to work. During a get-acquainted session with Rick and his wife, Rosemary, also a psychotherapist, Bud told them how his wife had changed. Before the accident, he said, Kara had been an affectionate companion and an active and adventuresome womanāa social, positive person, quick with a smile and a joke. She was attractive, was proud of her appearance, and took great care of herself. But the woman who had returned from the accident was very different.
This new Kara was a depressed, paranoid stranger who didn't care what she looked like, didn't want to be touched, didn't know what fun was, and didn't seem to care about peopleāor about anything, for that matter. Plus, Bud was doubtful about this Maui doctor. How could Rick help his wife when others had not been able to?
The Swords explained that they would be working with a new therapy based on understanding how the way we feel about the past, present, and future influences the way we conceive of what is possible in our lives. It seemed to be especially helpful with PTSDāeven with battered World War II veterans in their upper eighties and nineties who had been suffering for nearly seventy years from debilitating symptoms of PTSD due to the horrors they had lived through. This new treatment was succeeding where all other interventions had failed, making a significant improvement in their mental state and quality of life.
Bud and Kara agreed to give it a shot. āWe've got nothing to lose but time,ā Bud said. In fact, as they learned, there was much to gain through time perspective therapy.
PTSD basics
Post-traumatic stress disorder, commonly called PTSD, is an anxiety disorder that begins with a traumaāa horrific one-time event, like Kara's accident; continuing trauma, such as ongoing physical or verbal abuse; or a terrible event in which you have participated, such as war. You can even have PTSD as the result of being a caregiver or aid workerāan emergency room doctor or nurse, or a volunteer worker in a disaster like the earthquake in Haiti or Hurricane Katrina.
Whatever triggered your PTSD, that horrifying, frightening event overwhelms your ability to cope with daily life and may lead to all sorts of symptoms, including distrust, hyper-vigilance (always waiting for the hammer to fall), and hyper-irritability. Hollywood often portrays PTSD as nightmares, flashbacks, and being lost in past experiences to the point of becoming dysfunctional in the present. As one of the Swords' clients puts it, āIf it wasn't for my flashbacks, I wouldn't have any memory at all.ā
All of this and more can be true. But these symptoms are only a fraction of the turmoil that is going on inside sufferers. Inside they are reliving the event over and over again, reexperiencing the very same emotions; they infuse those fears and emotions into each moment, coloring past, present, and future with the same dark ink of fear.
the official definition: DSM-IV-TR criteria for PTSD
PTSDāonce called āshell shockā or ābattle fatigueā and ignored or dismissed as something that would disappear with timeāis now recognized by the American Psychiatric Association as a real disorder. And it is no longer necessary to be a direct victim to be considered as having been exposed to trauma:
In 2000 the American Psychiatric Association revised its criteria for this disorder in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, commonly called DSM-IV-TR:
Diagnostic criteria for PTSD include a history of exposure to a traumatic event meeting two criteria and symptoms from each of three symptom clusters: intrusive recollections, avoidant/numbing symptoms, and hyper-arousal symptoms. A fifth criterion concerns duration of symptoms and a sixth assesses [current] functioning.
Criterion A: stressor
The person has been exposed to a traumatic event in which both of the following have been present:
1. The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.
2. The person's response involved intense fear, helplessness, or horror. Note: in children, it may be expressed instead by disorganized or agitated behavior.
Criterion B: intrusive recollection
The traumatic event is persistently re-experienced in at least one of the following ways:
1. Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
2. Recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content.
3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: in children, trauma-specific reenactment may occur.
4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
5. Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
Criterion C: avoidant/numbing
Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:
1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma
2. Efforts to avoid activities, places, or people that arouse recollections of the trauma
3. Inability to recall an important aspect of the trauma
4. Markedly diminished interest or partici...
