In one of the largest published studied of cognitive behavioral therapy (CBT) for posttraumatic stress disorder (PTSD) more than one-third of the patients dropped out; the rest had a significant number of adverse reactions. Most of the women in the study still suffered from full-blown PTSD after three months in the study, and only 15 percent no longer had major PTSD symptoms. A thorough analysis of all the scientific studies of CBT show that it works about as well as being in a supportive therapy relationship. The poorest outcome in exposure treatments occurs in patients who suffer from mental defeat—those who have given up. Being traumatized is not just an issue of being stuck in the past; it is just as much a problem of not being fully alive in the present. One form of exposure treatment is virtual-reality therapy in which veterans wear high-tech googles that make it possible to refight the battle of Fallujah in lifelike detail. #RyanPhillippe 1 of 5

As far as I know, the US Marines performed very well in combat. The problem is that they cannot tolerate being home. Recent studies of Australian combat veterans show that their brains are rewired to be alert for emergencies, at the experience of being focused on the small details of everyday life. More than virtual-reality therapy, traumatized patients require real World therapy, which helps them to feel as alive when walking through the local supermarket or playing with their kids as they did in the streets. Patients can benefit from reliving their trauma only if they are not overwhelmed by it. A good example is a study of Vietnam veterans conducted in the early 1990s. When veterans were pushed to talk repeatedly about every details of their experiences in Vietnam, the investigators had to stop the study because many patients became panicked by their flashbacks, and the dread often persisted after the sessions. #RyanPhillippe 2 of 5

Unauthorized and abhorrent thoughts will sometimes invade the best human heart. Fear plucks the feathers from the wings of the soul and sits it naked and shivering in a vault, where the passing of a common hodman’s foot above sounds like the king of terrors coming. Because of their terror and fear from reliving their memories, some veterans never returned to therapy after being forced to talk repeatedly about their experiences in war, while many of those who stayed with the study became more depressed, violent, and fearful; some coped with their increased symptoms by increasing alcohol consumption, which led to further violence and humiliation, as some of their families called the police to take them to the hospital. Over the past two decades, the prevailing treatment taught to psychology students has been some form of systematic desensitization: helping patients become less reactive to certain emotions and sensations. #RyanPhillippe 3 of 5

However, is desensitization the correct goal? Maybe the issue is not desensitization but integration: putting the traumatic event into its proper place in the overall arc of one’s life. Desensitization makes me think of a small boy—he must have been about five—I saw in front of my house recently. His hulking father was yelling at him at the top of his lungs as the boy rode his tricycle down my street. The kid was unfazed, while my heart was racing and I felt an impulse to deck the guy. How much brutality had it taken to numb a child this young to his father’s brutality? His indifference to his father’s yelling must have been the result of prolonged exposure, but, I wondered, at what price? Yes, we can take drugs that blunt our emotions or we can learn to desensitize ourselves. As medical students, we learned to stay analytical when we had to treat children with third-degree burns. However, as neuroscientist have shown, desensitization to our own or to other people’s pain tends to lead to an overall blunting of emotional sensitivity. #RyanPhillippe 4 of 5

A 2010 report on 49,425 veterans with newly diagnosed PTSD from the Iraq and Afghanistan wars who sought care from the Veteran’s Affairs (VA) showed that fewer than one out of ten actually completed the recommended treatment. And exposure treatment, as currently practiced, rarely works for them. We can only process horrendous experiences if they do not overwhelm us. And that means that other approaches are necessary. Speaking of overwhelming, terror attacks are happening so much to civilians that we really do need to think about close our boarders and have to teach kids and adults how to process mass causalities. On 14 July 2016, a truck rammed into a crowd celebrating Bastille Day in the French Riviera city of nice, on Thursday night, killing about 60 people, during a French national holiday. The most pardonable of all liberties—the liberty of composing your mind, violence is never the answer. #RyanPhillippe 5 of 5