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.

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.

Relationship Therapy for LGBTQ+

by: Dr. Dino Zuccarini, C.Psych.

Living and loving in the social margins of a heteronormative world can create complexity in the relationships of individuals from the LGBTQ+ community.  In our early years, recognition of being different than members of your family of origin and peers can create significant attachment and self fears. We all need a sense of acceptance, emotional validation, approval, and admiration if we are to develop a strong sense of self and connection to others. Individuals from LGBTQ+, in many instances, may face abandonment, rejection, punishment, and abuse just for being different. These types of traumatic experiences create fears and distrust in others, mainly when early attachment figures are the individuals who are the source of rejection, punishment, and abandonment. Rejection also fills individuals with a deep sense of shame that comes with deep feelings of unlovability, insignificance, and worthlessness.  

The internalization of these experiences can create difficulties when fears, shame, and past hurts limit the capacity to trust and connect others. The clinicians at CFIR work to build more secure, resilient identities and strengthen interpersonal relationships in the LGBTQ+.  They support you to unpack the emotional residue of early distress in attachment and/or with pears and the impact of this residue on your attachments.

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.