An Interview with Frank Ochberg, MD on Post-Traumatic Stress Disorder (PTSD)
In this edition of the Wise Counsel Podcast, Dr. Van Nuys interviews Frank Ochberg, MD on the topic of Post-Traumatic Stress Disorder (PTSD). Dr. Ochberg developed an interest in PTSD based on his experience coming of age in the wake of the Kennedy assassinations (John and Robert), and the assassination of Dr. Martin Luther King, Jr. These events provoked him to help found a study group at Stanford University (where he did a medical residency) on the impact of cruelty and violence. Later, as associate director of the NIMH, he had opportunity to study terrorism and hostage taking situations. He played a role in developing the concept of "Stockholm Syndrome" wherein hostages develop feelings of love and admiration for their captors. He also played a role in getting the newly constructed PTSD concept to be accepted politically as legitimate diagnosis.
Dr. Ochberg defines PTSD as involving the following. First, someone is exposed to a life-threatening trauma causing them to feel great fear, horror and/or helplessness. Then, for at least a month, that person experiences unwanted, intrusive memories of the traumatic event in the form of flashbacks or nightmares accompanied by emotional numbness (a diminished range of emotional responsiveness from prior to the trauma) and increased anxiety and nervousness which may interfere with sleep and concentration abilities. PTSD is most associated with soldiers, but it equally affects victims of other violent circumstances such as rape and abuse, violent crime, automobile accidents and natural disasters. Women tend to develop the condition more often than men.
Dr. Van Nuys and Dr. Ochberg discuss the protective influence of emotional resilience with regard to PTSD. Some people are more prone to get PTSD than others, and there are various reasons why this is so. Genetically determined temperament seems to play an important role (where those people who are characteristically more optimistic and positive are protected more than those who are pessimistic and negative by nature), and also the early influence of intact loving family and caregiver relationships (which may extend throughout a close-knit community) play a role. People may also learn or fail to learn various coping mechanisms that help them to keep anxiety within tolerable limits, maintain self-esteem and also maintain important social relationships. Other protective skills involve the ability to be able to tolerate thinking about what might happen in the future, positive and negative. Events that interrupt the social-emotional maturation process interfere with the learning of these coping mechanisms. Dr. Ochberg stresses that people who cope successfully may still be quite anxious at times; it is not the absence of anxiety that defines good coping, but rather the ability to do productive things with it, and to take it for what it is (a warning of possible future danger) without becoming overwhelmed by it.
Dr. Ochberg discusses advances in the treatment of PTSD since the Vietnam War era. He stresses that two modes of treatment are helpful: anti-depressant medication, and exposure-based psychotherapy. Various SSRI antidepressants are useful in interrupting a tendency towards anxiety and obsessional thinking and so are useful in helping traumatized people to contain their anxiety symptoms. Exposure therapy then helps victims to confront, rediscover and learn to cope with their traumatic memories, resulting in a transformation of how those memories function to create symptoms.
Dr. Ochberg has developed a variation on exposure therapy which he calls the Counting Method. In this treatment method, the therapist counts up to 100 while the patient agrees to relive their trauma memory. At approximately a count of 50, the memory is at its most intense, and then by 90, the victim recalls a time when they were again safe. This intervention takes place well after initial rapport and trust is formed between therapist and patient; it is not something that can be done without that trust being in place. After the counting is done, the therapist and patient talk about what occurred. It has been Dr. Ochberg's experience that through this sort of procedure, patients will recall forgotten aspects of their trauma experience that help maintain PTSD symptoms. Through the recall process, some of the intensity of the PTSD symptoms are reduced. He has studied the efficacy of the Counting Method, in relation to the efficacy of EMDR, and has found that both techniques are effective in reducing symptoms. In his estimation, all effective exposure therapies for PTSD have in common that 1) the therapist believes in the method, 2) the patient believes and trusts in the therapist, and 3) believes that desensitization will occur as a result of pursuing the exposure agenda. With this foundation in place, a pairing of the trauma memory with the comfortable rapport and trust results in a lessening of the intensity of the trauma memory.
Dr. Ochberg talks about how important it is at the present moment in time (late 2008) to train general therapists in the various modalities for effectively treating PTSD. He has developed a DVD video program for this PTSD therapy training purpose which can be purchased through the Gift From Within PTSD website, run by Joyce Boaz which which he is affiliated.
Dr. Van Nuys asks Dr. Ochberg if he is familiar with the work of Edward Tick, Ph.D., whose thesis is that it is important for the culture to honor warriors, both in victory and in terms of their disability and failure. Dr. Ochberg is not familiar with the specific work cited by Dr. Van Nuys, but does affirm this principle. He relates an anecdote showing how modern western culture has largely lost touch with rituals and cultural expressions that lift up and support victims of violence.
Dr. Van Nuys asks Dr. Ochberg about his work with traumatized journalists. Through the Dart Center for Journalism and Trauma, he has helped to found the Dart Society where journalists who become traumatized through their work can come together for mutual support and education. He talks passionately about the important role that journalists play within democracy and how their "inside-outsider" roles (privileged to document and experience the raw reality of situations but not to be a part of the support mechanisms that help offset the impact of those situations on those who experience them first hand) makes them especially vulnerable and lonely.
At the interview's close, Dr. Van Nuys asks Dr. Ochberg to summarize what a person should do to try to help someone suffering with PTSD. Dr. Ochberg's advice, summarized from an article he wrote on "Partners with PTSD" for the Gift From Within website is for the interested supporter to educate themselves on the nature of PTSD, and then be a supportive, but not intrusive presence in the traumatized person's world, listening to them and helping to educate them and get them to treatment when they are ready for this to happen, and to help keep them from withdrawing without smothering them.
Links Relevant To This Podcast:
About Frank Ochberg, MD
Frank Ochberg, MD, a psychiatrist, has been a leading mental health authority since the 1960s. A graduate of Harvard University and Johns Hopkins University medical school, he has helped to define and research Post-traumatic stress disorder (PTSD) and Stockholm Syndrome, among his many accomplishments. From 1969-1979 he was a regional, division, and associate director of the National Institute of Mental Health. He then became director of the Michigan Department of Mental Health, a position he held for 3 years, from 1979 to 1981. Dr. Ochberg has also founded, headed or been part of a number of organizations dealing with PTSD and its treatment, including Gift From Within (founder), Critical Incident Analysis Group CIAG (founder) and The Dart Center for Journalism and Trauma (chairman emeritus).
A graduate of Harvard University and Johns Hopkins Medical School, Dr. Ochberg has dedicated his life and work to the prevention of the psychological consequences of violence. Following the assassinations of Robert Kennedy and Martin Luther King in the late '60s, Dr. Ochberg, then a resident at the Department of Psychiatry at Stanford University, helped form a group of students and faculty to study dimensions of aggression. Shortly afterward, he co-edited the book, "Violence and the Struggle for Existence." That was only the beginning-he directed his professional life into what would become a lifelong career of service, research, education, treatment, and international leadership in the interrelated fields of trauma, crisis and coping with violence and cruelty.
Dr. Ochberg has worked with the National Institute for Mental Health, the U.S. Department of Justice and the National Security Council. Though he was responsible for community mental health primarily in the United States, he was an advisor and instructor for numerous governments and international organizations.
Click here for a more complete online biography of Dr. Frank Ochberg. This Wikipedia entry has further details as well.
the impact of secondary wounding - anna nordstrom - Feb 1st 2011
I suffer from PTSD after witnessing and unsuccessfully trying to prevent a client from suiciding whilst employed as a youth worker.(In Australia) That was now 20 months ago and I am still unable to work.I believe this is from secondary wounding as I have been treated unfairly since day one. The 'feeling like a child' concept is strongly evident. I do not have any family in this country to give me support and am isolating myself from friends. Is there any research or court-cases that discusses the impact of secondary wounding as in A.Matsakis book: 'I cant get over it'? I need to get some justice to get over this and appreciate any help I can get.
va ignorance about ptsd - peter robinson - Mar 12th 2009
I was at the stanford study at palo alto in 1981. I had ptsd then and i have it now. the va has offered no treatment to me although my medical file is filled with my requests for help. after all these years i am still battling the va claims process to have my ptsd recognized as a disability that has ruined my life. the va was ignorant then and is still reluctant to treat ptsd. they wont change because you cant change a cucumber back into a pickle.