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.

What is Reconsolidation Therapy for PTSD?

In this initial blog of a three-part series on PTSD and Reconsolidation Therapy, we will provide an overview of what this treatment is and how it might help you overcome PTSD symptoms. In the second blog, we provide more information about how the treatment can be used with other evidence-based therapies. Finally, in our third blog, we specifically look at the benefits added with professionals such as front-line responders (paramedics, firemen/women, police/RCMP officers, medical staff) and military personnel (e.g., veterans, soldiers, navy) in mind.

Post-traumatic stress disorder (PTSD) is a disorder that affects 6-9% of people after they experience or witness a life-threatening, traumatic event. PTSD occurs when a person cannot process the traumatic event. Memories of the traumatic event continue to wreak havoc in a person’s life and are at the root of PTSD symptoms.

There are many reliable, evidence-based psychological treatments for PTSD. Some treatments target the symptoms of PTSD, while others target the memory of the traumatic event. Reconsolidation Therapy is a relatively new PTSD treatment that targets the memory of the traumatic event itself. Research studies substantiating the effectiveness of this treatment have been promising to-date. This treatment can be used as an adjunct or add-on treatment to existing evidence-based therapies.

How can this treatment work for you?

Reconsolidation Therapy combines psychological treatment strategies with medical intervention. The treatment works to activate your traumatic memory using psychological treatment strategies while using a medication (a beta-blocker called ‘propranolol’). The psychological treatment alongside the medication decreases the intensity of emotions associated with your troublesome traumatic memory. Research has shown after six weekly sessions, the emotional content of the traumatic memory is modified during reconsolidation therapy, and consequently, the symptoms of PTSD can decrease significantly.

Dr. Geneviève 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 this treatment to alleviate suffering associated with traumatic memories.

How Does Childhood Trauma Affect Relationships?

How we understand, feel, and behave interpersonally in adulthood stems from our experiences in our earliest relationships. As children, caregivers help us make sense of our experiences. They translate a physical reaction, such as crying, into a conscious feeling, thought, or desire. They do so by mirroring the child’s emotion, marking it with exaggerated facial, vocal, or gestural displays, and responding to it sensitively. They also put into words their own reactions, modeling ways to make sense of a child’s behaviours, and allowing the child to understand that people experience situations differently. These interactions foster what is called “mentalization”, which is the capacity to understand oneself and others in terms of possible thoughts, feelings, wishes, and desires. 

And what about children who did not benefit from such interactions with caregivers? In cases of child abuse and neglect, the child’s physical experiences are often ignored or met with anger, resentment, and irritation. These responses leave a child with the impossible task of processing his experience alone, therefore compromising the development of mentalization. It is not surprising that many adults having suffered maltreatment in childhood often encounter difficulties in their adult relationships. They may often feel hurt or angry in relationships as their understanding of others’ intentions or feelings is either lacking or inaccurate, leading to conclusions drawn by their own painful experiences in childhood. Therefore, behaviours such as withdrawing from a situation may be perceived as an intentional rejection, when, in fact, it may result from other intentions or needs. 

At CFIR, we can help you develop your mentalization skills by taking a step back from situations that trigger strong reactions. By learning how to think about how you feel and feel about how you think, we can support you to create stronger bonds in your relationship with others. 

Lorenzi, N., Campbell, C. & Fonagy, P. (2018). Mentalization and its role in processing trauma. In B. Huppertz (Ed) Approaches to psychic trauma: Theory and practice (p. 403-422). Rowman & Littlefield. 

Camille Bandola, B.Sc., is a counsellor at Centre for Interpersonal Relationships working under the supervision of Dr. Dino Zuccarini, C.Psych. She is currently in the fourth year of my doctoral program in Clinical Psychology at Université du Québec en Outaouais.

The Art of Play in Trauma Recovery

“Playing is itself a therapy,”

Donald Winnicott (1971)

One of the reasons I love Winnicott is that he realizes just how much a child misses out on if they do not have a chance to play or truly ‘be a kid’. This is especially the case for children who have experienced abuse, parental neglect, all resulting in them having to grow up too soon. 

To play means to allow creativity and imagination to flourish. To laugh. 

Be silly. 

Get messy.

As adults, we sadly also sometimes lose this ability to play. In my practice in Toronto (www.cfir.ca), I really start to see the impact of therapy on clients when we get to play together in session through laughter, art and using our imagination. As we share in these moments of creativity, it is incredible to see the bounds of trauma start to loosen its grip. 

As much as the psychodynamic field may have once admonished its therapists to be a ‘blank screen,’ people like Winnicott showed just how essential it is to let go and be silly. It is incredible to see how clients open up and come alive as we share in a private joke or get creative together. This sense of wonder is especially the case as a trauma therapist; while much of our session may delve into darker aspects of a client’s past, being creative and playful enables a start to freedom from these bonds. 

For me, playing comes on the wheel.

In the video below, I am doing what potters call ‘throwing off the hump,’ which means I throw smaller bowls on a large mound of clay so I can cut off the bowl and then immediately make another. This process is incredibly fun because while it produces many pieces (often tinier bowls), it is a rather messy process and requires a level of creativity that makes me feel alive. 

As someone who has also faced past trauma, I find that playing on the wheel, and being messy means that I can let go of some of my guardedness and simply play. I love the way it makes me feel like a kid again.

(This post is shared content from centredself.ca)

Jess A.L. Erb, D.Psychotherapy, R.P. (Qualifying) is a Registered Psychotherapist (Qualifying) who believes that the best therapy happens when a deep trust can form between counsellor and client. She works with adults and adolescents in an array of issues such as depression/suicidal ideation, anxiety/panic disorders, grief and loneliness, as well as all forms of abuse – emotional, physical, sexual, self-harm, and eating disorders. Before working as an associate at CFIR, she trained as a doctor in psychotherapy at the University of Edinburgh, UK.

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.

Talking To Your Child About Tragedy

by: Ali Goldfield, M.A., via Therapy Stew (www.therapystew.com), on Sept. 21st, 2013   

It’s always difficult as a parent to know how much to share with your child and how much to shield them from the tragedies that happen in the world around them. While it may seem like a good idea, at times, to try and protect them from all the bad things, depending on their age, it’s not always possible. Children pick up information from other kids at school, from the television and from social media. Talking to your child about a tragedy can help her understand what’s happened and actually help them begin to process the events and feel a bit safer.

It’s a personal decision whether or not to talk to your kids or not. It also depends on their age, their level of maturity and how closely they are affected by the tragedy. Every parent knows best for their own child. If you’re struggling with how to start, here are some ways to help:

Let Your Child Be The Guide

Find out what questions or concerns your child might have. Let your child’s answers guide your discussion. Let your child know that you will always be there to listen and to answer them. Try to make your child feel comfortable asking questions and discussing what happened but don’t force your child to talk if they aren’t ready.

Tell The Truth – In Moderation

When talking to your child about a tragedy, tell the truth. You can focus on the basics but it’s not necessary to share all the unnecessary and gory details. Try no to exaggerate or speculate about what happened and avoid dwelling on the magnitude of the tragedy. Listen closely to your child for any misinformation, misconceptions or underlying fears. Take time to provide accurate information. Share your own thoughts and remind your child that you’re there for him. Your child’s age will play a major role in how he or she processes information about a tragedy.

Talk to Them at Their Level

Talk in a way that’s appropriate to their age and level of understanding. But don’t overload the child with too much information. Elementary school children need brief, simple information that should be balanced with reassurances that the daily structures of their lives will not change. Middle school children will be more vocal in asking questions about whether they truly are safe and what is being done at their school.  They may need assistance separating reality from fantasy. High school students will have strong and varying opinions about the causes of violence and threats to safety in schools, community and society.  They may share concrete suggestions about how to prevent tragedies in society. They will also be more committed to doing something to help the victims and affected communities.

Be Ready to Have More Than One Conversation

Some information can be very confusing and hard to accept so asking the same question over and over may be a way for your child to find reassurance. Try to be consistent and reassuring, but don’t make unrealistic promises that nothing bad could ever happen.

Acknowledge and support your child’s concerns

Explain that all feelings are okay when a tragedy occurs.  Let children talk about their feelings and help put them into perspective.  Even anger is okay, but children may need help and patience from adults to assist them in expressing these feelings appropriately. Let your child know that all his feelings, reactions and questions relating to the tragedy are important.

Limit Media Exposure

Don’t allow young children to repeatedly see or hear coverage of a tragedy. Even if your young child appears to be engrossed in play, he or she is likely aware of what you’re watching or listening to — and might become confused or upset. Older children might want to learn more about a particular tragedy by reading or watching TV. However, constant exposure to coverage of a tragedy can heighten anxiety.

Monitor your own stress level

Don’t ignore your own feelings of anxiety, grief, and anger. Talking to friends, family members or mental health counselors can help. It is okay to let your children know that you are sad, but that you believe things will get better. You will be better able to support your children if you can express your own emotions in a productive manner. Get appropriate sleep, nutrition, and exercise. Kids learn from watching the grown-ups in their lives and want to know how you respond to events.

We have all awoken to disasters before, whether natural, manmade, accidental and terrorist-induced and it’s inevitable that we will wake to them again in the future. What you say to your kids and how you say it will change as they get older but the one thing that shouldn’t change is your validation of your child’s feelings and the fact that you will always love them and do your best to keep them safe. 

Read more about CFIR’s Child, Adolescent & Family Psychology Service & the Trauma Psychology & PTSD Treatment Service.

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