Recommended Trauma Treatments
The trauma treatments that TRR uses in its programming, and which we recommend, are ones that have been developed by leaders in the field of Traumatic Stress. All are known to rapidly, and effectively, reduce and/or resolve the most distressing symptoms of Combat Trauma.
EMDR Therapy (Eye Movement Desensitization and Reprocessing)
EMDR is the primary evidence-based trauma treatment in TRR's Warrior Camp® program. It was developed over 30 years ago and has been heavily studied and evaluated. It has been given an “A” rating, meaning “always appropriate and acceptable” by the VA and DoD, Clinical Practice Guideline for the Management of Post Traumatic Stress in 2004, and reaffirmed in 2010 and 2017. It is a primary treatment utilized by the Israel Defense Forces, as well as National Councils of Mental Health in the Netherlands, Ireland, Germany, France, the UK, and others.
Equine Assisted Psychotherapy (EAP)
Equine Assisted Psychotherapy (EAP) is a therapy model that uses horses (unmounted) as members of a therapy team. Horses are exceptionally sensitive and respond to intention and underlying emotion, enabling the human professionals to understand more deeply what is going on for the clients. EAP has been used with combat veterans for the past few years, both in the community and through some military–supported programs. Military veterans appreciate this modality as it does not require as much talking as other forms of treatment.
Equine Assisted Psychotherapy has been in practice for 18 years in the United States and internationally, and is noticeably effective in reducing hyper arousal, as well as re-establishing the capacity for attachment to others that has often been severely damaged as a result of traumatic combat experiences. TRR is conducting research into the efficacy of this model as a treatment for Combat Trauma.
Narrative Medicine teaches warriors the skills of radical listening and close reading of text to enhance the telling of one's own story. Initially developed by Columbia University as a way to teach medical doctors, surgeons, and other health care professionals how to listen for narrative instead of looking for symptoms, Narrative Medicine has been utilized by diverse groups seeking a deeper level of self expression. Adopted by TRR in 2017, Narrative Medicine offers warriors opportunities for reflection, creative expression and self-empowerment which complements the work done though other therapeutic modalities. Since writing is a process of discovery, no writing experience or level of skill is required. Conducted in group sessions during the program facilitates the building of community.
Yoga is a 5000 year old practice that is known to have many benefits to the body, mind and spirit. Because it is inherently regulating to the nervous system it can help people heal from many types of traumas. Our nation’s military personnel who have served in combat zones are routinely at high risk for trauma. Yoga has the power to help them regain balance, both physical and mental, as well as enhance strength, endurance, discipline and a sense of purpose.
The Department of Defense is well aware of the benefits of yoga, especially with regard to mental acuity and focus and has integrated yoga practice into complementary medicine programs on numerous military bases throughout the United States as well as on Landstuhl Air Base in Germany.
Sweat Lodge is a ceremonial practice that has been used by Native Americans and other indigenous people as preparation for going to war, and for welcoming warriors home from war, for centuries. It is intended as a spiritual and respectful path towards reconnecting to the earth and all its inhabitants, at the same time as it is a way to cleanse and purge toxins from the physical body. In this way, sweat lodge contributes to mental, spiritual and physical healing. It has been a modality offered by several Veterans Administration programs since the mid-90's.
What is EMDR Therapy?
Eye Movement Desensitization and Reprocessing Therapy is a powerful type of psychotherapy that was developed by Francine Shapiro in 1987 as a treatment for traumatic memories. Unlike traditional "talk therapy" that requires the client to tell the story of what happened to them, or exposure therapy which is structured to inhibit avoidance of disturbing material (and during which clients generally experience long periods of high anxiety), EMDR clients generally experience rapid reductions in subjective levels of distress early in the session.
EMDR Therapy evokes and integrates information on three levels - cognitive, emotional and somatic. During EMDR the client attends to emotionally disturbing material in brief, interrupted "sets" while simultaneously focusing on an external stimulus. Therapist-directed bi-lateral eye movements are the most commonly used external stimulus but a variety of other bi-lateral stimuli including tactile (hand-tapping) and audio are often used. The effect of attending to internal memories while focusing on an external stimulus is that the client can remain grounded in the present and remembers, rather than relives the past.
EMDR Therapy is an Adaptive Information Processing model. Adaptive information processing enables new associations to be formed between traumatic and non-traumatic memories which results in new learning, new insights and a reduction of emotional distress. With successful processing of material, the client's relationship to the original trauma has shifted. This is what is meant by the "processing of traumatic memories to an adaptive resolution." The result of treatment with EMDR is a decrease in emotional distress, a reformulation of negative beliefs into positive, life-affirming beliefs, and a re-setting of the nervous system. In short, EMDR reduces or resolves traumatic memories and enhances resilience.
For a description of the 8-step treatment model, please click here and for more detailed information on EMDR use the followings links: http://www.emdr.com or www.emdria.org
Here is a youtube video of a U.S. Marine being treated for Post Traumatic Stress:
Yoga is a 5000 year old practice that is known to have many benefits to the body, mind and spirit. Because it is inherently regulating to the nervous system it can help people heal from many types of traumas. Our nation’s military personnel who have served in combat zones are routinely at high risk for trauma. Yoga has the power to help them regain balance, both physical and mental, as well as enhance strength, endurance, discipline and a sense of purpose. The Department of Defense is well aware of the benefits of yoga, especially with regard to mental acuity and focus and has integrated yoga practice into complementary medicine programs on numerous military bases throughout the United States as well as on Landstuhl Air Base in Germany.
Here is a partial list of studies that have been done on the effects of yoga in a military population.
Effects of Yoga on Symptoms of Combat Stress in Deployed Military Personnel
Iraq Study Shows Yoga Warriors Method Reduces Symptoms of Combat Stress & Potentially PTSD
Mission Of Yoga Warriors
And some articles on yoga and warriors:
Some organizations doing yoga with warriors:
The Exalted Warrior Foundation facilitates a yoga instruction program that is designed for wounded warriors in military and veteran hospital facilities. Faced with the demands of both a physical and emotional recovery, yoga allows newly disabled veterans to reconnect both with themselves and their loved ones. Warriors with amputations, traumatic brain and spinal cord injuries have benefited greatly since the program began.
Exalted Warrior Foundation Locations:
Walter Reed Army Medical Center
James A Haley Veterans Hospital
Portsmouth Naval Hospital
Using Horses in Treatment
In recent years there has been an explosion of interest in horses. We can see this in television and magazine ads selling everything from clothing to perfume, to medications, in the return of the play, Equus, originally staged in 1973, in the growth of therapeutic riding facilities and, now, equine assisted psychotherapy. This renewal may, in part, be a social response to the film, The Horse Whisperer, in which Director Robert Redford's sensitive portrayal of the relationship between a traumatized horse and a traumatized young girl captured the hearts and the imaginations of so many people, especially psychotherapists. Whatever the reason, it seems that the horse, in all its manifestations, is emerging as a pivotal image.
Given their elusive spirit, their physical power and their great beauty horses elicit in us a primal desire to associate with their species. It may be because, as predators, we humans have an innate need to be reacquainted with our opposite natures - our more passive sides. Horses are prey animals. They have a tendency to submit, whether due to brutal pressure or compassionate leadership. And because of this inherent duality between predator and prey, our proximity to horses seems to open us to be softer, quieter and more present not only with them, but with ourselves.
The nature of prey animals is to be acutely aware of their environment at all times. This capacity to notice and respond instinctively to subtle shifts in their surroundings means that horses are often in a state of hyper arousal, not unlike human trauma survivors. For horses, this heightened awareness and hypersensitivity assures both their individual survival and the survival of the herd. They possess an inexplicable and limitless capacity for nuance and an unusual and often unrecognized ability to display emotional resonance, not only with other horses, but also with humans.
Some of us have begun to use the horse's instinctive "horse sense" and are now integrating them as partners in the therapeutic process with our clients. Observing their behavior with therapy clients gives a "window into the soul" of the client in ways the client often is unable to articulate. Horses in therapy sessions bear witness to whatever is present to them. And they respond. Moving about freely in an open pen, they often choose to engage in ways that are intuitively helpful. They give us feedback through body language, mirroring what they understand about the client's deepest feelings and intentions. This mirroring can be almost imperceptible to the untrained eye. Except, now we are working closely with horse professionals who do have trained eyes.
Through their eyes and what they report about what the horses are doing, psychotherapists are able to turn the horse's behavior into a metaphor for the client. This often far surpasses what is possible in a talk therapy session in the confines of an office. For one thing, the client is moving, which decreases arousal. And no matter what the horse is doing the client cannot help but notice that the horse is remaining attentive to them, is with them on a very profound level. Even if the horse's behavior towards the client is less than positive, the client is more apt to listen to the horse's message without shame, embarrassment or defensiveness.
Equine Assisted Psychotherapy
Equine Assisted Psychotherapy (EAP) is a powerful psychotherapeutic approach that utilizes horses as part of a therapy team. The other members of the team are a licensed mental health professional and an equine specialist professional. All work with the horses takes place on the ground only - there is no riding.
Working with horses can help people discover and overcome unhealthy patterns and behaviors. This is because the horse, as a non-verbal communicator, gives immediate feedback about actions and body language through their own response. Horses are exceptionally sensitive and are able to mirror emotions as well as behavior. We learn what is going on with our human clients by watching what the horses are doing.
EAP for Combat Trauma and First Responder Trauma
The application of equine assisted psychotherapy to the treatment of traumatized individuals, including and especially combat veterans and first responders, is a new and important development. Exposure to traumatic events produces a massive upheaval in the arousal system. Many trauma symptoms express themselves as either hyper or hypo nervous system response. A few of these are irritability and anger, sleep disruption, hyper-vigilance, and an exaggerated startle response.
The other system that is disrupted with multiple traumas, trauma of extended duration or that which is inter personally inflicted is the attachment system. This gives rise to many of the symptoms now considered to be complex trauma, some of which are impaired relationships with family and friends, a generalized social withdrawal, and a loss of previously sustaining beliefs, among others.
Working in close proximity to horses seems to be of extraordinary help in addressing these challenges. There are a few reasons this is so:
- Horses live in the present moment. They respond to what is and to intention. Interacting with them teaches mindfulness, which can be a window into reclaiming life as it is lived in the here and now.
- Horses are active. Working with them necessitates movement and grounding, which decreases arousal and dissociation. Mindfulness, grounding, movement and working in the present moment all increase the individual's capacity to experience the present rather than responding to the traumatic past.
- Horses are social animals. Their natural curiosity and playfulness is, at times, so powerful as to supersede their interest in food. Being invited to interact with them overcomes isolation and supports people's interest in novelty. This helps to re-engage the frontal lobes, increasing the capacity to think.
- Horses are non-judgemental. They accept people and other horses as they are, without bias or discrimination.
- Horses live in a herd. They model non-predatory group behavior and can teach people how to interact without violence.
EAP Can Help With Life Skills:
- Problem solving
- Communication skills
- Relationship building
- Self control
- Setting healthy and safe boundaries
- Calming the nervous system
With Trauma Symptoms:
- Irritability and anger
- Sleep difficulties and constant fatigue
- Difficulty concentrating, remembering and thinking
- Withdrawal from social activities and friends
- Problems at home
- An increase in accidents
- An increase in taking unnecessary risks
- Physical complaints and medical illness or fear of medical illness
- A significant increase in the use of alcohol and other substances
With Moral Injury:
- Difficulty connecting
- Feelings of being unworthy
- Feelings of not deserving contact
- Intense shame or guilt
- Self punishment
- Suicidal ideation and attempts
Horses and Moral Injury
At TRR we work with horses on the ground only. We know that going to war often results in an injury to the moral core of our warriors - their very heart and soul. This is what Moral Injury is about. It is an existential and/or spiritual crisis that arises when human beings are responsible for, or feel responsible for, taking a human life, witnessing the taking of human life, or being unable to prevent the taking of human life.
Moral Injury is what happens to warriors who have been trained to override the intrinsic aversion to killing - necessary among war fighters for survival in combat. The difficulty is that when human beings kill other humans, it feels like a violation of a moral code that we all live by. It is felt very deeply by many and is often not spoken about or explored, especially in traditional PTSD treatment.
Warriors whose Moral injury is not being addressed are not receiving adequate care.
Karl Marlantes, author of What It Is Like To Go To War, said it this way, “Killing someone without splitting oneself from the feelings that the act engenders requires an effort of supreme consciousness that, quite frankly, is beyond most humans. Killing is what warriors do for society, Then when they return home, society doesn’t generally acknowledge that the act it asked them to do created a deep split in the psyche, a psychological and spiritual weight most of them will stumble beneath the rest of their lives. Warriors must learn how to integrate the experience of killing, to put the pieces of their psyche back together again. For the most part, they have been left to do this on their own.”
We cannot allow our warriors to do this on their own, because the legacy of that strategy has resulted in an unrelenting high rate of suicide. People who feel they have done something terribly wrong, even if ordered to do so or if necessary for survival - theirs or their battle buddies - are sometimes left thinking they deserve punishment. They, at times, unfortunately - and tragically - punish themselves.
Working with horses who are at liberty, free to come and go, to approach a spiritually wounded warrior, or not - enables the horse’s instinctive, nonjudgmental and forgiving nature to tap into that morally injured part of the warrior that needs to be healed.
More about our approach to Moral Injury in the arena is on our Resources page
Narrative Medicine teaches warriors the skills of radical listening and close reading of text to enhance the telling of one's own story. Initially developed by Columbia University as a way to teach medical doctors, surgeons, and other health care professionals how to listen for narrative instead of looking for symptoms, Narrative Medicine has been utilized by diverse groups seeking a deeper level of self expression. Adopted by TRR in 2017, Narrative Medicine offers warriors opportunities for reflection, creative expression and self-empowerment which complements the work done though other therapeutic modalities. Since writing is a process of discovery, no writing experience or level of skill is required.
Writing their own trauma narrative helps warriors to integrate the dissociated parts of their psyche and their trauma experience, creating new healing neural pathways lined with their own words. In addition, keeping a written record of events and emotions offers a kind of external memory bank and coping tool for warriors with brain injury, allowing them to make more consistent and confident clinical progress toward healing. As warriors write their way home, they can also choose when and if they share parts of their narrative with others in their home or in wider circles of support, reducing their isolation. Whether shared or kept private, narrative writing helps veterans to reclaim the words, truths, stories, and strengths that had been stripped away by the winds of war.
Conducted in group sessions during the program, Narrative Medicine facilitates the building of community.
Here are some groups using the power of the written word with military veterans ~