How Might Reconsolidation Therapy Benefit First-Line Responders and Military Personnel?

Soldiers, veterans, military officers, and first-line responders, such as police officers, firemen/women, paramedics, and medical staff are specially trained and selected to deal with complex and life-threatening situations. These situations can be terrifying, often involve the possibility of risking one’s life. Memories of these events can linger and be difficult to process, often resulting in post-traumatic stress or post-traumatic stress disorder (PTSD). When these recollections repeatedly return during the day or while sleeping, the distress created by these memories’ return can seriously impair well-being and functioning.

Emergency responders are at high risk for PTSD. These individuals often live with the recurring recollections and emotional residue caused by traumatic situations and events beyond the limits of what is tolerable by a human being. These thoughts can seriously impact the minds and bodies of those mandated to rescue, heal, and protect others. The psychological and emotional toll of occupational distress on the front lines are often high. For example, suicide rates among police officers are three times higher than the civilian population. Reconsolidation Therapy offers a short-term treatment option as an adjunct or add-on to existing PTSD treatments to alleviate some of the emotional distress associated with traumatic memories.

Addressing traumatic memories has typically required a longer-term therapy, which can be difficult to endure for some first-line responders and military personnel seeking quicker solutions to alleviate their distress. Longer-term treatment solutions may not be tolerated as well by some, particularly those who wish for a quick return to work. For first-line responders who have PTSD, Reconsolidation Therapy may shorten some aspects of PTSD treatment given the added benefit of improving distress associated with traumatic memories and current PTSD symptoms.

Dr. Genevieve Boudreault, D.Psy, C.Psych is a clinical psychologist at the Centre for Interpersonal Relationships (CFIR). Dr. Boudreault, C.Psych. provides psychological services to adults that have experienced traumatic events and are suffering from complex (C-PTSD) and post-traumatic stress disorder (PTSD). She is certified to practice Reconsolidation Therapy and supervises a team of therapists that provides these treatments to alleviate suffering associated with traumatic memories.

Reconsolidation Therapy at CFIR: An Adjunct Treatment for PTSD

Reconsolidation Therapy is a short-term PTSD treatment for people who have been exposed to traumatic events (e.g., violence, accidents, rape, horrific scenes, combat-related experiences). First-line responders, such as police officers, firemen/women, military officers, paramedics, and medical staff, often have out-of-the-ordinary experiences that leave emotional residue and difficult memories. Events including (but not limited to) car accidents, violence, and sexual assault can result in traumatic memories that wreak havoc in our everyday lives. Reconsolidation Therapy treatment works by directly activating the traumatic memory of the event and uses both psychological and medical intervention to reduce PTSD.

Several evidence-based treatments address the problematic symptoms of PTSD, including more commonly used ones such as Exposure Therapy/CBT. While existing treatments have demonstrated their effectiveness, the distress associated with re-visiting traumatic memories can be daunting and result in some clients avoiding treatment. Reconsolidation Therapy is an add-on treatment that integrates aspects of existing evidence-based psychological treatments with medical intervention.

Here’s how it works:

Dr. Alain Brunet has developed reconsolidation therapy. Initial research findings suggest that this treatment can significantly reduce PTSD symptoms. This relatively new PTSD treatment uses a combination of six sessions of talk therapy under the influence of safe medication, a beta-adrenergic blocker known to lower blood pressure. In Reconsolidation Therapy, the medication essentially blocks the traumatic memory’s emotional arousal aspect from binding with details of the event. You will remember details of the events but with significantly less emotional intensity than before treatment.

Gradually, over four to six sessions lasting 25-30 minutes, the emotional distress associated with the memory shifts so that recollection of the event may be comfortable but no longer accompanied by the same amount of emotional distress. In short, this process does not change the memory but reduces the intensity of the emotional content.

Clinicians at CFIR who offer clinical services in the Trauma Psychology and PTSD Service now provide Reconsolidation Therapy as an adjunct treatment to current treatment protocols that are in use. (e.g., CBT, EMDR, psychodynamic, etc.).

Dr. Genevieve Boudreault, D.Psy, C.Psych. is a clinical psychologist at the Centre for Interpersonal Relationships (CFIR). Dr. Boudreault, C.Psych. provides psychological services to adults that have experienced traumatic events and are suffering from complex (C-PTSD) and post-traumatic stress disorder (PTSD). She is certified to practice Reconsolidation Therapy and supervises a team of therapists that provides these treatments to alleviate suffering associated with traumatic memories.

How Frontline Workers are Being Impacted by COVID-19 and What They Can Do

As we all navigate through the uncertain time of COVID-19, frontline workers face a set of particularly unique challenges. What follows is a list of ways that frontline workers are being affected by COVID-19, with some suggested coping techniques. It is my hope that, in creating this list, frontline workers will feel better understood and validated, while those not on the frontline may learn how to better offer their support. 

Isolated from Family/Friends

Being isolated from loved ones is perhaps one of the most challenging aspects frontline workers face. During a time when they may need it most, they may not be able to receive the same love and support from their family that they usually would. Keep in mind that, although frontline workers may have to or choose to isolate themselves from family physically, it doesn’t mean that they have to isolate themselves emotionally. 

Be creative – read bedtime stories over the phone or prop up a phone or tablet with video chat for dinner time. It might still be possible to meet in person, but with a degree of separation like a glass door or window. Also, activities like walks might remain an option, so long as there is physical distancing. Even short, positive, love-affirming texts throughout the day can make a world of difference. 

Direct Interaction with the Disease

Imagine a poisonous snake is living somewhere in your home. Every time you open the refrigerator to get food or hop into bed, you risk being bit. This is the reality that frontline workers are facing. Every person that they interact with and every surface they touch is a risk of contracting this disease. Their stress response is heightened for every moment of their day as they are at risk and may feel they can’t let their guard down. 

Frontline workers may benefit from practicing short-term stress-reduction techniques throughout their day, such as grounding or breathing exercises, as well as practicing long-term techniques like meditation, exercise, or therapy outside of work. Continue to take precautions as necessary to help minimize risk. 

Generally Chaotic Work Environments & Long Hours

Whether its hospitals at capacity or grocery stores swarmed with people, frontline workers are generally working in a chaotic environment at this time. Furthermore, working long hours can also be draining, regardless of the type of work. Imagine being used to going for an evening walk and now suddenly having to be able to run a marathon. The demand for frontline workers continues to grow as confirmed cases of COVID-19 increase, and as there is a need to cover shifts for those that are out sick.  

Try different relaxation techniques before and after shifts and, if possible, create a sanctuary or safe space at work in order to have a place to calm down or take a break quickly. Frontline workers are providing an essential service and are helping their community – use that as a basis to create meaning and satisfaction from work and to help maintain a positive attitude. 

Lack of Equipment/Resources

Some workplaces have been extremely aggressive in trying to keep their workers safe. For example, grocery stores are sanitizing carts, have put up a plastic divider between customers and cashiers, and not accepting paper money. Despite best efforts, however, many places are experiencing a shortage of personal protective equipment (PPE), such as face masks. This significantly changes how frontline workers interact with people and how they do their jobs, and it can also lead to a general sense of uneasiness or not feeling safe. Furthermore, the added layer of PPE also affects the patient relationship by way of creating an extra barrier. 

Just today, Prime Minister Trudeau has pledged $2B to buy personal protective equipment, in which Canadian companies are being enlisted to provide critical medical supplies like ventilators, surgical masks, and test kits. Until then, however, continue to focus on things that can be controlled rather than dwelling on things that can’t, and continue to remain positive and practice self-affirmations. Don’t repress worry or stress, however, but give proper times to process and handle those concerns. 

Increased Risk for Mental Health Issues

Many frontline workers are reporting an increase in depressive symptoms, anxiety, insomnia, distress, and trauma-related disorders. Through direct contact with patients, as well as through vicarious trauma of other frontline workers’ experiences with COVID-19, and witnessing illness and death around them all the time, frontline healthcare workers are at significant risk of developing post-traumatic stress disorder, as well as increased suicidal thoughts and/or behaviors. Some could also turn to unhealthy coping mechanisms and even addiction to help get them through this time of overwhelming anxiety, confusion, instability, and loss. Despite these growing mental health concerns, many still have to continue working and treating the ill. 

It is important to remember that there can also be post-traumatic growth, not just distress during these times. There are important resiliency factors that could help buffer against developing any of the above-mentioned mental health disorders. These factors include, but are not limited to: not avoiding the situation and self-disclosure of distress or trauma to loved ones; having social support available to you and being connected with others (practicing safe physical distancing); spirituality, or having a sense of community or belonging; having an identity as a survivor, and finding hope and optimism wherever you can; helping others, and finding a positive meaning in the trauma.

Frontline workers should know that they are valued and appreciated for all that they are doing and sacrificing for the better of their community. I am offering pro bono services (1-5 sessions) for frontline healthcare workers in Ontario (through the Ontario COVID-19 Mental Health Network), and reduced cost services for other frontline workers. Please reach out if you need support – we are all in this together. 

Dr. Brianna Jaris, C.Psych. is a clinical psychologist at CFIR. She has extensive experience in psychological assessment and diagnosis and the treatment of a wide range of psychological issues, including trauma, depression, anxiety. She is currently the head of CFIR’s Trauma and PTSD service. 

How Common is the Experience of Trauma?

by: Andrea Kapeleris Ph.D.

More common than you think! About 20-50% of children and teens who have experienced trauma meet the criteria for Post-Traumatic Stress Disorder (PTSD) and nearly 75% also experience depression and substance use (Elwood, Hahn, Olatunji, & Williams, 2009). Statistics also show that about 14% of people exposed to a major stressor go on to develop PTSD (Terhakopian, Sinaii, Engel, Schnurr, & Hoge, 2008), and women are about twice as likely as men to develop PTSD after a trauma (Kessler, Berglund, & Demler, 2005). Stressors can be one-time events that cause actual or threatened death or harm to yourself or a loved one (such as, a car accident, sexual assault, mugging, natural disaster), or they can include on-going negative and damaging experiences – such as, chronic stress resulting from military service, or childhood experiences in which there was repeated damage to the attachment relationship between you and your caregiver. These chronic experiences can shatter a child’s sense that the world is benign, the world is meaningful, and the self is worthy, and often results in avoidance coping and an increase in overall level of arousal and anxiety (Roth et al., 1997).

Symptoms of PTSD are Normal Reactions to a Non-Normal Experience

  • Re-experiencing the event in a number of ways including, flashbacks, nightmares, or vivid memories that come to you unexpectedly 
  • Avoiding any reminders of the event (people, places, or things associated with the event), and a feeling of numbness
  • Increased feelings of anxiety or emotional arousal

Treating Trauma

Overstuffed Cupboard Metaphor

The mind is like a pantry cupboard. When a traumatic event occurs, it is as if very large and oddly shaped boxes were hurriedly stuffed into the pantry. Since there was no time to properly place the boxes in the pantry in an organized fashion, each time you open the pantry to get something you need, a box suddenly and unexpectedly falls on you – startling you and possibly hurting you! The same thing happens when our mind experiences trauma. Due to the sudden and overwhelming nature of the traumatic event, the mind doesn’t have the opportunity to process all of the emotions associated with it, and as a result, unpleasant memories or emotions may come to us when we least expect them too. For example, you may become startled by an unsettling memory or emotion when you are relaxing at home, watching TV, or spending time with friends. As a result, you may begin to avoid things you previously enjoyed. 

The purpose of therapy is to help you organize this pantry. We need to take each box out of the pantry slowly and carefully, examine its contents, and then place it in its proper place. Once all of the boxes are organized accordingly, you will be able to enter the pantry without fear, and will no longer need to avoid that part of your home. Similarly, the goal is to slowly process the trauma and place events and their accompanying emotions into sequential order. In this way, your mind will be able to integrate the trauma and make sense of it. You will be able to think more freely and move forward with your life. 

Fight or Flight mode

When we encounter a traumatic event (something that threatens our physical or psychological integrity) our bodies enter a process called the “Fight or Flight” mode. This mode is evolutionarily necessary and served an important purpose – in the times of cavemen and women when our ancestors were being chased by predators (e.g., a tiger) all of the resources in their bodies left the frontal cortex (the part of our brain used to reflect on our thoughts and feelings, and make decisions) and automatically went to their muscles (to prepare them to flee or fight the predator), and also went to pump up their heart rate, breathing, and overall adrenaline (again, to make it easier for them to flee or fight predators). In modern times, when we are faced with a trauma, our bodies go into ‘Fight or Flight’ mode in order to protect us. Later, any experiences, people, places, or things that remind us of the trauma stimulate our body to again go into this fight/flight mode in case we need to be protected again. Part of our work in therapy is to help your body and mind recognize that this threat occurred in the past and that you are no longer in danger. We foster this safety on many different levels:
1) Physiologically: We must help the physical body itself feel safe and come down from overarousal. This may partly be achieved through learning relaxation strategies or overcoming avoidance-coping strategies that maintain and intensify anxiety. 

2) Emotionally: We must help the mind itself feel safe and come down from overarousal. This is achieved through:
a) processing the trauma as described above in ‘the cupboard metaphor’; 
b) learning Emotion Regulation strategies

Emotion Regulation

Emotion regulation is a process of 1) identifying and increasing awareness of your feelings (e.g., what are the names/labels for the vague and sometimes uncomfortable sensations that happen inside?), and 2) ‘sitting with’ the sensations that go on inside and experiencing the waxing and waning of your feelings – all feelings do wax/wane, come and go – the only thing we can be certain of is change from moment to moment. Physiologically, our bodies experience of any emotion follows a bell-shaped curve (i.e., it must come down from its peak) – our bodies cannot maintain the high emotional arousal indefinitely – but sometimes, our feelings about our feelings (feeling angry that we are sad, for example) may intensify our original emotion. In therapy, we help to disentangle this, and in effect, help you to regulate your emotions. Importantly, we also begin to look at your feelings as an important signal that there is something inside that needs our attention

Read more about our Trauma Psychology & PTSD Treatment Service.