Resolution of Dissociated Ego States Relieves Flashback-Related Symptoms in Combat-Related PTSD: A Brief Mindfulness Based Intervention.

A novel therapeutic approach conceptualizes PTSD-related flashback triggers as the activation of latent dissociative structures called dissociated ego states (DES), which are fractured aspects of self beyond cognitive control. Using mindful attention, therapists can engage these states without emotional dysregulation, recovering dissociated cognitive resources and deactivating the structure, without requiring exposure to traumatic memories. A 9-step intervention is described with a case example of a Vietnam veteran who had PTSD symptoms for 49 years; significant gains were maintained at 21 months follow-up. This mindfulness-based approach targeting dissociated ego states may offer rapid, durable relief from chronic PTSD symptoms and potentially reduce treatment costs.

Study at a glance

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.