(The purpose of Soul Care Conversation is to create a place to generate dialogue, initiate thoughtful consideration for the challenges our veterans face each day, share ideas of veteran and family well-being and healing, and spark within all of us a call to be engaged with the veteran and caregiver community. Click here to visit the forum and join the conversation!)
Last week I concluded the outline for the Soul Care Conversation that we began over one year ago. We discussed networking with community agencies and governmental organizations regarding veteran care. As we look to future conversations please consider topics that we have discussed that you desire to go deeper, or offer suggestions on a particular topic that you desire to discuss. For this week, I received a suggestion from a colleague that desired to be in conversation about guilt and shame as it pertains to Post Traumatic Stress Disorder (PTSD).
Recently, I read an article in the News and Observer that discusses a Duke study suggesting that Cognitive Process Therapy (CPT) significantly reduced Post Traumatic Stress Symptoms.
The study, in the journal JAMA Psychiatry, is the largest randomized clinical trial to date to apply cognitive processing therapy, or CPT, which has been used among civilians for decades, to active-military patients who are suffering from PTSD. It found that while using the treatment in both group and individual sessions significantly reduced PTSD symptoms, individual treatment was nearly twice as effective. (“Duke study shows therapy effective for military sufferers of PTSD,” News and Observer, written by Gavin Stone, 28 November 2016)
CPT is one of numerous forms of psychotherapy being used with our veterans diagnosed with PTSD. Therapies that have exhibited a track record of success include;
- cognitive behavior therapy (CBT)
- cognitive process therapy (CPT)
- eye movement desensitization and reprocessing
- exposure therapy
The VA and DoD also have used additional therapies as reported by the Washington Post to include;
- equine therapy
- alpha stimulation
- guided imagery
- aqua therapy
To understand CPT, let’s briefly review two factors; methodology and outcome.
- face the trauma through a detailed written account
- share the account with a therapist
- work within a group process
- break the pattern of avoidance
- enable emotional processing
Emotional processing allows for the clarification and modification of cognitive distortions. In other words, CPT provides the trauma survivor the opportunity to begin to look at the cause of the trauma and its effects in a different way. The bottom line is that the trauma survivor can choose to move beyond being a victim into being a stronger person by living into the possibilities of growth from the trauma experience.
The article continues to flush out the thought process of a trauma survivor, especially a combat warrior. The trauma survivor see themselves as a victim, but they also blame themselves for the event.
CPT is a method of treatment that involves evaluating the thoughts and beliefs associated with a patient’s traumatic experience, which for many in the military involves blaming themselves for events in combat that are out of their control, according to Patricia Resick, a professor of psychiatry and behavioral sciences at the Duke University School of Medicine and lead author of the study. Resick said that this tendency comes from the belief that in a “just world” good things happen to good people, which for some could also mean that if something bad happens it’s because you’re a bad person. “Instead of looking to the perpetrator of the trauma, they look to themselves to assign blame,” Resick said. “What we do is we systematically lead them through a series of steps to teach them to ask themselves questions so they can make more balanced statements about themselves.” (“Duke study shows therapy effective for military sufferers of PTSD,” News and Observer, written by Gavin Stone, 28 November 2016)
People experience guilt for various reasons. Many find it difficult to move past guilt which can lead to chronic psychological issues, such as depression and anxiety. I have read research, surveys, periodicals, and books that all look at treatment from a psychotherapy model.
However, guilt and shame have implications beyond the psychological component. From the perspective of a chaplain or a pastoral counselor, trauma and trauma care must also reflect a spiritual dimension.
For one year I took part in a trial program, PTSD Pathways, at Fort Belvoir 2013-2014. The program included psycho-education, CPT, CBT, relaxation techniques, coping skills, and the understanding of relationships.
I learned that the primary focus of CPT was to help me re-conceptualize my traumatic event in order to reduce its ongoing negative effects. The Pathways program using CPT proved somewhat beneficial in my initial healing. However, the psycho-therapy did not go far enough. CPT lacked the spiritual component.
Trauma effects not only the body and mind, but also the spirit. From my foxhole, the behavioral health community has been reluctant to recognize the relevancy of the spiritual component in our veteran care.
However, recently the conversation about PTSD now includes another dimension, moral injury. (We discussed in detail in an earlier conversation.) Some behavioral health experts describe moral injury as a psychological scar of war.
Moral injury is unlike PTSD, which is based on fear from feeling one’s life threatened. Moral injury produces guilt and shame from something done, or not done, or witnessed that goes against one’s values. Men and women have returned from war broken and their diagnosis is wrongly labeled PTSD because their wound was not recognized as a moral injury. Often PTSD and moral injury overlap. But, it is imperative that the therapists/counselors differentiate the two.
I believe one of the reasons I continued to struggle after completing the Pathways program was the absence of the spiritual component in my work toward healing. I worked with diligence attempting to overcome my fear from my trauma, however, I had yet to work on the damage left by decisions made in war.
Moral injury has taken on life within the behavioral health community. Should not the faith community become involved in the discussion, offer ideas for healing, and partner with the behavioral health community for our veterans?
IMPLICATIONS FOR THE FAITH COMMUNITY
For the purpose of this conversation, let’s look at a possible spiritual therapeutic model. What should be some of the critical components? For me, a model may include;
- Acknowledge – take an honest assessment of thoughts and behavior, then acknowledge guilt and shame, and anger
- Forgiveness – choose forgiveness of self in the trauma experience as well as others who may have had responsibility
- Self-acceptance – renounce self lies like; I’m no good, I’m nothing, I’m worthless, I can’t be loved, and accept the reality of being a child of God
- Renewal – begin to retrain mind
- Amends – restoration involves a direct way to repair what has been damaged or broken (for the veteran, maybe difficult to go back to place of injury, however, there are other ways; contribute to refugee or orphan fund in the area of the war, volunteer at a shelter or soup kitchen, etc)
- Accountability – be in a community that offers accountability and support
Do you have a model? What would you include? What components should we include that are missing from the model here? Have you included a spiritual dimension in the care of a veteran diagnosed with PTSD? What does that look like?
I hope this sparks a conversation among us. This is an important aspect of caring for those affected by trauma.
I pray that you have a very blessed Holyday season and a Happy New Year. Until next year….thank you for the conversation.