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Todd Vance, photo courtesy of NBC San Diego
Martial arts classes may be a good therapy alternative for combat veterans looking to overcome PTSD. NBC San Diego recently featured an article and video clip about a mixed martial arts class led by Todd Vance that is helping veterans overcome PTSD and adjust to civilian life.
Click here to watch the the 2-minute video about this therapeutic class for veterans.
Obviously, such classes can empower survivors and help them overcome that sense of helplessness that so many feel in the aftermath of trauma. The physical actions and mental discipline learned in martial arts classes may also help survivors channel energy, reprogram responses, and discover skills to regulate emotions. The veterans in Todd Vance’s class also report the bonding and camaraderie with other trauma survivors in the class was healing.
Similarly, trauma expert Bessel van der Kolk has also observed that self-defense and martial arts classes can be good adjuncts to trauma therapy. However, caution should be used before embarking on any sort of martial arts or self-defense class. In one PTSD forum, several people commented that they had been “triggered” in self-defense classes, suffering flashbacks, anxiety, and helpless feelings during and after the class. So, if you want to try this approach, be sure the class is led by an instructor who is familiar with trauma. The instructor should know how to ease someone into increasing challenges and respond if they do experience PTSD symptoms. As a therapist, I would also want to do some trauma “clearing” using Rapid Resolution Therapy, EMDR, or similar methods prior to someone entering one of these classes, so they are less likely to be “triggered.”
Have you or anyone you know had any experience using martial arts to overcome trauma? Let me know your opinion about using this as an intervention or adjunct to trauma treatment!
Courtney Armstrong is a Licensed Professional Counselor as well as a Master Practitioner and Associate Trainer in Rapid Resolution Therapy. She has a private counseling practice in Chattanooga, TN where she specializes in treating trauma, anxiety, and grief. To contact Courtney, visit www.courtneyarmstronglpc.com.
Should there be a separate diagnostic category for complex PTSD related to childhood trauma in the DSM-V?
Physicians and researchers such as Bessel van der Kolk, MD, Robert Pynoos, MD, and Marylene Cloitre , PhD think so. Over a year ago, these medical professionals formed a task force advocating that a diagnosis called Developmental Trauma Disorder be in the DSM-V.
The task force notes the diagnostic criteria for the current diagnosis of PTSD was based on symptoms of World War II combat veterans. We know that many people who have have experienced chronic childhood abuse or neglect also exhibit some PTSD symptoms. But, they also display problems with emotional regulation, learning disabilities, and attachment that are given separate diagnoses and treated differently.
At a conference I attended in February 2010, Dr. van der Kolk opined this lack of an adequate diagnostic code resulted in dangerous consequences for kids. He estimates that as many as 8 million children in the U.S.A. have been diagnosed with Bipolar Disorder and/or ADHD and prescribed large doses of medication. Yet, he’s observed the root of the problem for many of these kids lies in disrupted attachment, abuse, or neglect that is often left untreated.
Similarly, as abused kids reach adulthood they are given diagnoses of recurrent depression, anxiety disorders, personality disorders, or somatization disorders because they don’t match the current criteria for PTSD. Not only do these patients have to live with the stigma of other diagnoses, but it also leaves the root cause of the problem untreated.
Fortunately, Cloitre et. al just published an article in the August 2010 addition of the American Journal of Psychiatry that lends more support for this new diagnosis. Their research illustrates that treatment for issues related to chronic childhood traumas is different. See my post titled “Complex PTSD requires emotional skills training + trauma focused therapy” for information about this research.
Similarly research by Pitman, et al. presented at the 2008 ANCP meeting found that diminished volume of the hippocampus and ventro-medial pre-frontal cortex seemed to make a person more vulnerable to developing PTSD. We know that people exposed to chronic stress, especially as a child, tend to have diminished volume in these areas. Having diminished volume in these areas makes it more difficult to regulate emotions and assemble memory.
Diagnosing these issues appropriately has important implications for treatment. For example, Cloitre’s research suggests we have to do a combination of emotional skills training and trauma focused therapy for optimal treatment response. For children, it suggests family counseling with parenting support and coaching is needed for optimal treatment responses.
Even if the new diagnosis is accepted for the upcoming DSM-V, it would only be approved as a diagnosis for children and adolescents at this time, not adults. Still, it would be a step in the right direction in terms of getting these folks appropriate treatment.
What do you think? Do you think there needs to be separate diagnostic category for complex PTSD related to childhood trauma in the upcoming DSM-V?
For more information about this proposal and the suggested diagnostic criteria, visit www.traumacenter.org.
Courtney Armstrong is a Licensed Professional Counselor who specializes in trauma therapy. She has a private practice in Chattanooga, TN and also trains mental health professionals in creative ways to treat trauma. To contact Courtney, visit her website at www.courtneyarmstronglpc.com
Nat'l Institute of Mental Health, NIH Medical Arts
Did you know that you don’t have to use EMDR or painful exposure techniques to clear the emotional charge of a traumatic memory? All that is required is keeping the client “emotionally present” as they are describing the details of the event.
This concept was introduced to me many years ago by Dr. Jon Connelly. Now, neuroscience discoveries, and trauma researchers like Bessel van der Kolk, MD and Dan Siegel, MD are coming to similar conclusions.
Why does this work? I believe it works because when we keep the client emotionally present, we are helping to prevent the amygdala from activating the fight/flight response. The amygdala is the little almond shaped structure in the mid-brain that is triggered if the deeper mind senses danger. (See the Amygdaloids video on this blog for more info about this.)
The problem is, when the amygdala and fight/flight response go into high gear, the brain inhibits the function of the hippocampus and parts of the pre-frontal cortex. The hippocampus and certain aspects of the pre-frontal cortex are responsible for integrating memory and tempering emotional responses. If these parts of the brain are “off-line,” then the memory stays seared into the deeper brain as a non-verbal, implicit, felt memory.
When a memory stays in this implicit form, associated sensory details like smells, times of year, sounds, and visual images can trigger the same feelings of terror as the original event. However, these triggers are often “unconscious” to the client.
One goal of any trauma therapy is to integrate the traumatic memory over into conscious, explicit memory. To do this, we have to keep the hippocampus and pre-frontal cortex open and on-line. If you have the client emotionally re-live the event, guess what? You inadvertently activate the fight/flight response right there in the session and cause the hippocampus and pre-frontal cortex to go offline again.
“Recollecting’s not forgetting, it’s vivid rehearsal of pain. It keeps fear in my thoughts. It reminds me of that day. It keeps fear in my brain.” The Amygdaloids, from their song Fearing.
For a client to recall a traumatic event without “vivid rehearsal of pain,” you have to use tools that keep them emotionally responding to the present situation. This seems to allow the deeper brain/amygdala to realize the event is over so that it no longer fires off the fight/flight response at the mere recollection of the event’s details.
This has huge implications for how we practice psychotherapy and I am actively staying on top of research related to this phenomena.
Courtney Armstrong is a Licensed Professional Counselor who specializes in treating trauma, anxiety, and grief. She has a private practice in Chattanooga, TN and trains mental health professionals in an approach called Rapid Resolution Therapy. To contact Courtney, visit www.courtneyarmstronglpc.com.
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