Traumatic incident reduction: Encyclopedia II - Traumatic incident reduction - How does TIR compare with other techniques for addressing traumatic stress?

Traumatic incident reduction - How does TIR compare with other techniques for addressing traumatic stress?

Up until recently, there have been two main approaches to PTSD:

1. Coping techniques.
2. Cathartic techniques

Some therapists give their clients specific in vivo methods for counteracting or coping with the symptoms of PTSD. These clients learn to adapt to, to live with, their PTSD condition. They learn, for instance, how to avoid situations that trigger them, how to distract themselves when they are triggered, how to rebreathe in a paper bag to avoid hyperventilation. Women who have been assaulted or raped may take self-defense classes.

Others encourage their clients to "release their feelings", to have a catharsis. The idea is that past traumas generate a certain amount of negative energy or "emotional charge'", and the therapist's task is to work with the client to release this charge so that it does not manifest itself as aberrant behavior, negative feelings and attitudes, or psychosomatic conditions. This notion, derived from Freud's libido theory, is an "hydraulic" theory of psychopathology. Charge generated in past traumas supposedly exerts a pressure towards its expression. If not expressed in affect appropriate to the experienced trauma, it must express itself in inappropriate ways. Therapists espousing this theory use methods such as implosion therapy, psychodrama, and focus groups to help the client release the charge.

Coping methods and cathartic techniques may help a person to feel better temporarily, but they don't actually improve the client's stability. Instead, what you get is a "Chinese Dinner Syndrome", so called on an analogy to the relatively large proportion of short-term energy (from carbohydrates) in Chinese cuisine: clients feel better temporarily after coping or having a catharsis, but the basic charge remains in place, and shortly thereafter they are hungry for more therapy. In cathartic work, the presence of an affective discharge indicates that the client has contacted a past trauma and "worked it through", but not that she has eliminated it. Coping strategies don't provide a permanent solution either. A week, a day, or an hour later, some random environmental stimulus such as a loud noise or the sound of helicopters can trigger anew the same charge.

TIR could be regarded as a kind of "exposure technique", in that, as with exposure, the point of TIR is to help the viewer become more aware of the traumatic incident. Exposure theorists rely on a desensitization model, in contradistinction to TIR's person-centered model, but the two techniques converge on the need for repeated exposure to the trauma.

(Editors note: Direct therapeutic exposure is a tool long used by the United States Department of Veterans Affairs and others to treat PTSD. Research by Lori Beth Bisbey has shown DTE to be more effective than no intervention at all, but not as effective as TIR.)

There are certain features of TIR that do not form part of the DTE approach, however:

a. TIR embodies the concept of an end point, with certain particular characteristics. DTE's "end point" occurs when the client feels little or no distress as a result of confronting the incident. In TIR, we usually await the onset of positive emotion, not just the absence of negative emotion. Plus there are the other components of an end point, as described in TIR: insight, extroversion, and frequently the expression of what the intention was that the viewer made in the incident.

b. TIR is stricter about not permitting any input from the facilitator concerning detail or content of the incident. In DTE, the therapist reads a script to the viewer, and the viewer goes through at the therapist's pace. In TIR the viewer confronts only what she feels comfortable confronting on any particular run-through. Exposure in TIR is client-titrated, rather than therapist-titrated.

c. In TIR, we endeavor to reach an end point in a single session; in DTE, working on a given incident typically takes a few sessions.

d. TIR includes specific ways of checking for earlier and similar incidents that might be triggered when running through a later one. A sequence of incidents can be traced back to its root in a single session and resolved.

e. When the client suffers from unaccountable uncomfortable feelings, emotions, sensations, psychosomatic pains, and unwanted attitudes, but there are no obvious major traumas in evidence that could be addressed, a type of TIR called "Thematic TIR" can be used to trace these "themes" back to the incidents they came from and eliminate them, also in a single session.

More recently, proponents of certain techniques have claimed that they can permanently eliminate the effects of PTSD. Charles Figley and Joyce Carbonell at Florida State University have recently studied these techniques -- TIR, Francine Shapiro's Eye Movement Desensitization and Reprocessing (EMDR), NLP's Visual / Kinesthetic Disassociation (VKD), and Roger Callahan's Thought Field Therapy (TFT) -- to determine what the active ingredient was. Although their study wasn't designed as an outcome study, it suggests that all four techniques are effective.

Like TIR, EMDR and VKD contain elements of exposure, but they also contain other elements, such as inducing eye movements or producing other repetitive, bilateral stimuli (as in EMDR) or creating a deliberate state of dissociation (as in VKD). Otherwise they differ from TIR in the same ways that DTE does. TFT is utterly different from TIR, relying, as it does, on manipulating acupuncture meridians.

Adapted from the Wikipedia article "How does TIR compare with other techniques for addressing traumatic stress?", under the G.N U Free Docmentation License. Please also see http://en.wikipedia.org/wiki