Resolution of Dissociated Ego States Relieves Flashback-Related Symptoms in Combat-Related PTSD: A Brief Mindfulness Based Intervention.
Genine P Smith, Glenn Hartelius
Military psychology : the official journal of the Division of Military Psychology, American Psychological Association January 1, 2020 DOI: 10.1080/08995605.2019.1654292
Summary
A mindfulness-based approach has shown promise in treating chronic PTSD symptoms, particularly flashbacks, by targeting dissociated ego states rather than traumatic memories. In a case study of a Vietnam veteran with 49 years of PTSD, significant symptom relief was achieved and maintained for 21 months. The intervention involves a 9-step process that allows individuals to access dissociated cognitive resources safely. This innovative method could lead to reduced treatment costs and improved outcomes for veterans, potentially transforming PTSD therapy.
Abstract
A novel understanding and therapeutic approach to the treatment of PTSD-related flashback triggers are described. Triggered responses are conceptualized as the result of latent dissociative structures of neural organization and psychodynamic functioning activated by current events. The dissociative structure - here described as a dissociated ego state (DES) - reflects a fracturing of executive functioning resulting in a delimited aspect of self that is not under cognitive control or subject to cognitive inhibition by the self of daily experience, and is the psychological construct behind intrusive PTSD symptoms. Use of a mindful attentional state permits regulated access to the DES (therapeutic engagement without risk of emotional dysregulation) so that dissociated cognitive resources can be recovered and the dissociated structure deactivated. This may relieve maladaptive responses and behaviors associated with the DES in a profound and durable way, without the need for exposure to or recovery of traumatic memories. Based on this understanding, a 9-step intervention is introduced with a case example of a Vietnam veteran suffering PTSD symptoms for 49 years with significant gains maintained at 21 months follow up. These findings demonstrate rapid and durable resolution of chronic PTSD symptoms through a mindfulness-based approach that focused on deactivation of dissociated ego states, in contrast to targeting trauma memories. If proven efficacious, this novel approach may result in reduced treatment costs and improved outcomes for veterans suffering with PTSD.