Is This PTSD Treatment Too Good To Be True?

FLORA LICHTMAN: Hi, this is Flora Lichtman, and you’re listening to Science Friday.

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Today on the show, can a treatment for PTSD be painless?

YASMIN TAYAG: To claim that you can treat PTSD without having the patient face their fears, it’s just sort of anathema to– [LAUGHS] the field.

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FLORA LICHTMAN: About 7% of veterans experience PTSD, and that number can be as high as about 30% for those who’ve served in a war zone. And yet, PTSD has been treated roughly the same way since the disorder was first recognized roughly four decades ago. Patients are instructed to revisit trauma head-on until the memory no longer creates an emotional response. But this process is so harrowing that over half of veterans are unable to complete the full course of treatment.

So what if there was a way for PTSD treatment to be virtually painless? Yasmin Tayag, staff writer at The Atlantic, investigated a controversial treatment called reconsolidation of traumatic memories and explored the challenges of even studying a treatment that bucks conventional wisdom. Yasmin, welcome back to Science Friday.

YASMIN TAYAG: Thanks so much for having me.

FLORA LICHTMAN: So you begin your piece through the lens of a patient, Jeff Turner. Tell us his story and how he ended up trying this alternative therapy.

YASMIN TAYAG: Yeah. So Jeff Turner was an Iraq war veteran. And when he told me about his trauma, he referred to an experience where he was leaving a mess hall. He was having breakfast like any other day. And then the next thing he knows, the mess hall blows up, and there’s another explosion right by him.

He kind of panics. He ducks under a mail truck. And next thing he knows, somebody is chasing after him and is saying, Sergeant, you’re covered in blood. And fortunately, his injury was relatively benign. He didn’t get hit in the head. He got hit in the wrist and leg.

But very soon after the event, the symptoms of PTSD began. And that looked like flashbacks and irritability, memory loss. And they continued for years, even though he was trying all sorts of other treatments, including the gold standard treatment, which is called prolonged exposure. This is like exposure therapy.

And somebody suggested he try this new therapy called reconsolidation of traumatic memories. And at this point, Jeff is like, whatever. Sure, let’s try it. And after four sessions, he told me his flashbacks just disappeared. And he literally described it like magic.

FLORA LICHTMAN: Wow. So how is this treatment different from the standard treatment for PTSD?

YASMIN TAYAG: So for a long time, the go-to treatment has been something called prolonged exposure. Prolonged exposure is a form of talk therapy that essentially involves the patient living through the traumatic memory over and over and over again until it no longer elicits the same kind of fear.

So reconsolidation of traumatic memories, it’s essentially a painless treatment. Big claim. And to continue like the movie analogy, I think of RTM as similar to Inception, where they go into the person’s mind to manipulate a memory directly without having the patient experience that trauma over and over again.

FLORA LICHTMAN: Hmm. What are the sessions like?

YASMIN TAYAG: So they’re pretty weird. Well, they start off fairly normal. You’re in a room with your therapist, and you set the start and end of the memory that you’re going to be tackling that day. And then the therapist has you close your eyes. And you’re told to imagine yourself in a movie theater where your trauma is playing out on the screen. Only you then become disembodied, float up to the projection booth, and are watching your seated self watching the screen watching your traumatic memory.

FLORA LICHTMAN: Everybody who does this is instructed to imagine themselves in a movie theater, and then float out of their body and watch their traumatic experience on the screen?

YASMIN TAYAG: Yes. This is part of the protocol. And as you watch your traumatic experience play out on the screen, your therapist is in the room with you, watching you. And the moment you show the tiniest flicker of discomfort, they’ll have you stop. And so they never want you to experience discomfort.

And then your therapist will say, OK, tweak the video so that it’s a little easier to watch. Maybe you’ll turn it into a black and white film, or maybe you’ll make everyone a stick figure. And you’ll keep repeating this process over and over, tweaking your film until it is easy and boring to watch, no longer eliciting emotion. And that’s stage one of this process.

And then on to stage two. You return to the movie theater, but you step into the film itself, which is much more vivid than it was in the first stage. And the idea is you have to learn to withstand this as well.

And finally, when that is easy enough to do, you move on to the final stage where the therapist asks you to just reimagine a totally different ending to your trauma– completely different. It can be anything. And that is the end of the treatment.

FLORA LICHTMAN: Is there science underpinning this? Do we know if you can rewrite your memories in this way by putting yourself in a movie theater and floating out of your body?

YASMIN TAYAG: So yes. reconsolidation of traumatic memories is based on this theory of reconsolidation. And it’s this idea in psychology that memories that we might have once thought of as fixed, set in cement, are not actually permanent. You can modify them by reactivating them in certain ways.

RTM is a way of manipulating that process, of reactivating that memory, editing it a little bit, and then filing it back away into your brain in its altered state. And it’s supposed to stay that way in your brain permanently.

FLORA LICHTMAN: You talked to a patient for whom it seemed to work. Have there been clinical trials or studies looking at its effectiveness, this treatment’s effectiveness?

YASMIN TAYAG: So there are four clinical trials, all published in peer-reviewed journals, but they’re all done by the creator of RTM. The outside experts I spoke to about these existing trials generally agree that they were not done very well.

FLORA LICHTMAN: Is it being evaluated now?

YASMIN TAYAG: So right now, a very well-respected scientist with the army named Michael Roy has just completed the first large-scale, truly comparative clinical trial, where he compares people treated with RTM and people treated with the gold standard, prolonged exposure.

And this study is really exciting because it truly will be the first time that RTM has been studied in a very rigorous, very scientific way. And the results are not out yet. But the early data that he’s shared with me all seem to suggest that RTM is worthwhile. It can work as well as the gold standard treatment.

FLORA LICHTMAN: Hmm. How is RTM viewed by the field?

YASMIN TAYAG: A lot of people just don’t about it. But those who have heard of it, at least the ones I spoke to, were all kind of skeptical. I think there is resistance in the PTSD research field for two reasons.

One is that there just isn’t that much data on RTM. But the second is that I think there’s a philosophical reason people are pushing back. Because to claim that you can treat PTSD without having the patient face their fears, it’s just sort of anathema to [LAUGHS] the field.

Everything that we know about prolonged exposure is based on this idea of you have to face your fears. Even people outside of the medical field, we have sayings that are like, you have to face your fears, face your demons. It’s just in our culture. So the idea that you don’t have to face your fears in order to get past them seems a little implausible, I think, to a lot of people.

FLORA LICHTMAN: You contrast TM with psychedelics. In the piece, you go to a conference, and the psychedelics session is the keynote, and there’s hundreds of people there. Whereas, the RTM session is in a tiny ballroom and few people are there.

YASMIN TAYAG: Yeah.

FLORA LICHTMAN: Are psychedelic treatments for PTSD showing promise?

YASMIN TAYAG: Yeah, they really are. But what I will note is that most of the ongoing studies on psychedelics, they combine the psychedelics with talk therapy. Often, it’s the old prolonged exposure therapy.

And so I found that kind of interesting that people were so excited about this new treatment paradigm when, in fact, it’s not totally new. It’s almost like an add-on to something that has already existed for a long time.

FLORA LICHTMAN: Hmm. You spent a year reporting on RTM. It’s a little niche. Why did you think it was worth covering?

YASMIN TAYAG: I was aware that there was a real feeling of stuckness in the PTSD treatment world. For years, we’ve been hearing about the staggering rate of suicides among veterans with PTSD. And I had known from previous reporting that a lot of the current treatments weren’t working.

And so when I heard about RTM, I think like most of the people I interviewed for this story, I thought, that seems unlikely. I’m skeptical. But there’s always been a part of me, and there is even now after I’ve written the story, that thinks, why not try?

We’ve clearly exhausted the existing possibilities. We’ve shown their limits. And especially with a treatment like RTM which doesn’t appear to have a downside. Even if it doesn’t work, it’s not like the process is painful or expensive. Why not try?

But I think regardless of any philosophical qualms, theoretical qualms you might have with a treatment like this, I think you really just have to remember why you’re doing this. At the end of the day, does the patient have less severe symptoms? And if the answer is yes, then I think that should be an indication that you keep going.

FLORA LICHTMAN: Well, thank you so much for sharing your reporting with us.

YASMIN TAYAG: Thank you for having me. It’s been such a pleasure to talk about it.

FLORA LICHTMAN: Yasmin Tayag is a staff writer for The Atlantic based in New York City.

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Thanks for listening. Don’t forget to rate and review us if you like the show. And you can always leave us a comment on this segment on Spotify. We’d love to hear from you. Today’s episode was produced by Shoshannah Buxbaum. I’m Flora Lichtman. Thanks for listening.

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