now most everybody's heard of
post-traumatic stress disorder or PTSD
but the disorder is not well understood
by our culture or 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 traumatic
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
re-experiencing symptoms arousal and
avoidance typically people get rien
seing 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 situations that
remind them of how they felt during 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 queued 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 of the
roles of them but rheic Speier Ian Singh
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 well 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 can't 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 has adapted 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 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 as humans were 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 gravity 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 kwik-e-mart to
get some milk you have an internal file
folder for what this experience is all
about you know that milks 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 a lottery
tickets we know exactly what this is
and the more the event matches our
internal file shoulder the less
memorable it is months will 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 kwik-e-mart and there's
an elephant in the back and that's man
he's taken up five or six rows there's
mountains with Ho Hos and Twinkies you
make your way over that everything and
get your milk and ask the cashier hey
man what's up with this elephant the
cashiers 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
kwik-e-mart 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 a
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
alpha elephant we're gonna 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 within
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 experience you'll 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 avoid situations
for a long enough period of time for the
hot potato to cool now once it's 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 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 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 a 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
and a 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 telehealth
technology as some of my research has
suggested now no treatment is a hundred
percent 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
experienced 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 its uses of front-line treatment
for PTSD yet it is not widely available
to 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 health care 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 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