Recently the Department of Defense (DoD) made a bold decision to introduce Positive Psychology to all active military in hopes of reducing the incidence of PTSD. I appreciate the boldness, but question the choice of method.

Positive Psychology provides an antidote to the more traditional, symptom-focused, disability-obsessed aspects of standard psychotherapy, and instead examines and promotes authenticity, productivity, the appreciation of beauty, creativity, forgiveness, altruism, gratitude and connection with community.

Indeed, building upon a person’s strengths is a key tenet of my profession - social work - and always has been.  I’m all for this fruitful legacy of the late, great Abe Maslow (the psychologist who put terms like “self-actualizing”, “peak experience” and “human potential movement” into common parlance).

I've no doubt positive psychology has been good for a host of people, most notably middle school kids and teenagers suffering from iffy self-esteem, adolescent angst and hormonal doldrums.  It’s also been shown to reduce depression in self-selected, online subjects.  But I just can’t see how it can make a dent on posttraumatic stress, especially the soul-killing kind that comes from the unique horrors of combat.

PTSD is a world apart from depression.  You can improve one without touching the other.  Jennifer Strauss’ studies at Duke and the Durham V.A. showed that the guided imagery intervention she tested reduced all three clusters of PTSD symptoms, but didn’t effect depression a bit. That’s because they’re separate conditions, and the imagery tracks chosen as the intervention addressed posttraumatic stress only.

PTSD sits in the primitive, survival-based structures of the brain and nervous system.  Even deep-dish talk therapy barely touches it, because it's the wrong chunk o' brain involved. (Far too uptown - definitely over-qualified.}  PTSD is the result of perceived threat to life and limb, so we're on the turf of the reptilian brain stem and mid-brain.  Posttraumatic stress deals in perception, sensation, images, emotion and muscular reactivity. That’s why guided imagery and hypnosis can reach it. So can certain kinds of acupoint tapping and body work.  But talking and thinking?  Not so much. 

And by definition, Positive Psychology is Talking & Thinking, Lite.  It’s designed to be that way. 

It certainly makes sense in personal growth workshops and corporate team building exercises to write down 3 things that went well each day and try to assess why.  It’s useful to identify and ponder personal strengths and see how they fit with those of others.  But to think that exercises like these can counter the profound soul loss, despair and deep disorientation that comes from watching, experiencing and/or doing terrible things - things that assault your identity, sense of safety and reason, not to mention the mores and ethics you grew up on?  Not gonna happen, people. I wish it could, but I just don’t see how.

When I discussed the whys of this choice with a Pentagon official who was present at the meetings where the decision was made to use Positive Psychology, it was explained to me that PP was not seen as something to treat PTSD sufferers.  Rather they hoped this would be a skill set troops could learn pre-deployment, in hopes of increasing their resiliency and thus mitigate the likelihood of acquiring PTSD later.  

Again, I don’t see it. Whatever gains are accrued from positive self-talk and reframing negative perceptions, they’re bound to fragment along with that first terrifying IED explosion that blows up your friend’s legs and your sense of justice along with it.

Now, $120 million is a hefty price tag for an intervention with no specific track record for either a military population or for PTSD prevention - especially one that doesn't get up close and personal to those critical primitive brain structures.  Indeed, this method barely air-kisses the neocortex.  

Again, I’m impressed that the Department of Defense is doing its best to break out of the mold and initiate new ways of dealing with combat stress. And I think they had the right idea in adopting a resilience/training model, as opposed to a therapy/healing format.  There is much in the coaching, non-pathologizing style of Positive Psychology that, unlike standard counseling, is highly compatible with the military. So kudos to them for all that.  It’s just that the method itself is unlikely to have the mojo to prevent PTSD.  (To be fair, we have no evidence yet that anything does.).  And I’ll be thrilled if I’m wrong on this.

The V.A., on the other hand, has been – at least at the top levels – pretty risk averse and stodgy, getting behind only a few things:  Prolonged Exposure Therapy and a few related protocols grounded in cognitive behavioral therapy  (PET is based on learning theory, where overblown survival responses are extinguished through sheer repetition in a safe setting) .  

These techniques are often effective when completed, but (1) they’re labor intensive; (2) it’s hard to avoid dropouts, because of the initial distress they create in the first few sessions; (3) they require 8-12 weeks with a specially trained therapist – rare in many parts of the country; (4) they’re met with reluctance by many V.A. therapists, who find it unnecessarily harsh on the patient; and (5) they’re avoided by most service people, because it’s counseling, after all.

Yet this is what the V.A. presses on staff and patients alike, often to the exclusion of other methods.  Even EMDR (Eye Movement Desensitization & Reprocessing), which has been well researched and which gets pretty decent results for a substantial number of people, usually without the same levels of distress catalyzed by PET, did not make the very short list of officially endorsed therapies at the V.A.  

My fear is that the DoD will get blowback from the Feckless New and run screaming back to the Feckless Old.  And the V.A. will see what’s going on over there and feel justified in its rigidity.

That would be a shame. There are a lot of effective, portable, user-friendly, uncomplicated, inexpensive protocols going on, using imagery, biofeedback, Healing Touch, meditation, hypnosis and several EMDR-like acupoint tapping protocols. (In the interest of full disclosure, I think we have one of ‘em – guided imagery targeted for posttraumatic stress). 

Let's hope someone who decides these things is paying attention and not easily discouraged.  We need to use the right methods targeted for these extraordinary conditions.  They exist.  There’s even some research on them.  We can use what we know now to cobble together some effective treatment combinations, even as we’re learning more about how to do it better. 

Let us hope.

All best,