I would like to provide this information from an upcoming book about a new approach to resolving the symptoms of complex PTSD. In the initial of this method we have successfully collpased all the symptoms for 77% of PTSD casualties within the initial intervention period. Please let me know of you want any more information or if there is any way I can help. Thanks Ironrod. Introducing “The Walters Method” For Releasing PTSD As a result of a long period of working with a wide variety of individuals operation in high intensity situations – torpedo operators in submarines, emergency responders in the nuclear power industry, emergency managers in local government and executive teams in multinational corporations – I realised that the way we train these people to operate in emergency situations is often flawed. The military method of drill, drill and drill again until it becomes an automatic response cannot be translated to the civilian or business community because there is just not the time available to repeat the training enough times for it to become an instinctive response. And there is valid debate whether an instinctive response, by rote, is appropriate to the complexity of a large organisation working its way through a corporate crisis while under public and governmental scrutiny. So this led me to research stress and in particular stress in first responders – such as police, fire and ambulance crews. As a result of this research I learned numerous stress reduction techniques. Some were just totally flaky! Some were mainstream and effective, others not so. There area variety of new techniques which have been used to counter PTSD most notably Cognitive Behaviour Therapy (CBT) and Eye Motion Desensitisation and Reprogramming (EMDR). Both of these techniques have reported success with treating PTSD. But there is significant debate about the long term efficacy of these procedures and the degree of abreaction they cause in the PTSD casualty. The Training Programme The Walters Method has been developed against 3 fundamental principles: It should be easy to learn and self administer It should be easy to deliver, even over the phone It should not cause the casualty any additional pain So based on these three fundamentals, we next addressed the most common problems for dealing with complex PTSD. These are: Re-traumatisation – which runs the risk of destabilising the casualty – even to the point of suicide Communicating core issues in a non threatening way Effectively releasing the negative memory/emotion Identifying deep rooted secondary issues Obtaining closure Supporting a credible vision of the future Now to look at the tools we had to work with. During my research into stress resilience I identified a number of complimentary techniques which could be applied to this situation. These included such things as Trauma Release Technique (TRT) - my own derivative of the Emotional Freedom Technique, Neuro Linguistic Programming, The Sedona Method, Tapas Acupressure Technique (TAT), aromatherapy, Part therapy, Brainwave Entrainment, Terminal Release Communications (TRC), autogenic relaxation, life mapping, visualisation, goal setting and path working. None of these techniques in isolation held all the answers but presented together, sequentially, or in combination has produced remarkable results. The techniques are integrated into a seamless process and taught to the PTSD casualties during initial intervention phase. Over time we have developed and refined this protocol to the point where it now is. There are always new discoveries, or better ways of presenting or delivering the training and as these come along we will be very quick to test them, see how they can improve the protocol and then, if they add value to what we do, we will adopt them. The protocol is delivered in two phases. The first, the intervention phase, starts with an intensive 3 day residential programme (afternoon, full day and morning). The purpose of this is to collapse the core issue as quickly and safely as possible, release the associated emotions around the issue, almost invariably these include anger, guilt, shame and sadness (usually in that order). Also during the residential time the casualty is given a variety of techniques to improve their sleep. Once the initial release has been achieved many people say they feel there is something missing in their head. And so we quickly work to create a positive future vision, set some goals and establish a support network to help the person make the transition from PTSD casualty to functional human being. It is common for PTSD casualties to express no hope for their future, even a physical inability to think more that one day at a time. One casualty, who had constant thoughts of suicide, and had actually 3 unsuccessful attempts to his name, told us he had only one rule to live by. His rule number 1 was wake up alive tomorrow, rule number 2 was - see rule 1. It is always extremely distressing to hear how many of these veterans think about and plan their own death. In some cases they repeat these thoughts on a daily or hourly basis. Many more engage in irresponsible behaviour such as high speed, reckless driving or even commit self harm. So creating a credible, coherent vision for the future and providing the support the casualty needs to make that transition is an important consideration of this protocol. From experience approximately 30% of people attending the course find secondary issues emerge after they have completed the initial residential programme. Usually this happens in the first 3 – 7 days after the initial one to one session. So a series of follow on calls are made by the intervention team to monitor the progress of the recovering veteran. These are a short telephone call to establish the well being of the veteran. If any issues are reported follow on telephone coaching is arranged. In virtually all cases this is sufficient to address the problem. This intervention support is provided for the first 4 weeks after the residential course. Once this is completed the level of support is reduced to fortnightly calls in the second and third month and eventually monthly calls for the next three months. When other support agencies are engaged, it is intended to hand off the long term care to as suitably trained counsellor or field worker. This will free the intervention team to stay focussed on the critical initial four week period of the programme. The handover will be conducted at a three way meeting with the veteran, a member of the intervention team and the field worker. A significant concern at the beginning of the programme is that of re-sensitising and losing a casualty before they have had the benefit of learning the protocol. So even before someone is loaded onto the course there is a screening process. Although complex PTSD always has some form of co-morbidity or secondary personality disorder we insist that casualties coming on training are free from alcohol dependence and drug usage for at least six months. We also require that they have been independently diagnosed with PTSD. This is a training programme to teach PTSD casualties a series of tools and techniques to help them overcome the symptoms of PTSD. So we need to be sure that the person is actually suffering from PTSD and not some other mental health issue which is outside the scope of this work. The final pre-requisite for joining the course is that the casualty must self refer. Many casualties are in denial and many others are suppressing the core issues about their injury. In either case these people will not respond as well to the training as a casualty who has come to the realisation that they need help and are willing to make the commitment to do whatever it takes to obtain release form their PTSD injury. The residential course is run over three days. The course starts after lunch and all of the first day is spent on group activities. Once the joining routine is complete the casualties come together to learn the first, and extremely important defensive technique, the anchor. The first part of the initial intervention consists of creating a multi-sensory anchor which can be used any time a trainee experiences extreme intensity from their memories. This is followed by creating a life map, which provides a very non threatening visual expression of their life and trauma and gives an opportunity to identify primary and secondary issues which need to be addressed. The final session teaches the casualties the tools that will be used during the intervention sessions. The evening is given over to informal conversations and building rapport. No sleep aids are provided for the first night. After breakfast an assessment of sleeping patterns is conducted and then the second day of the course is taken up with a series of one-to-one intensive interventions. Typically these take 2 hours which limits the course load to a maximum if 5 for each trainer. When the delegates are not involved with the intervention they are given time to experience a variety of support tools including autogenic relaxation and brainwave entrainment (we did try light goggles but these were too reminiscent of weapons flashes). Also delegates are encouraged to keep working on their life maps and monitoring the progress they have made. An intervention starts by reviewing the life map and clearly identifying the primary and secondary issues which need to be addressed. Every precaution is taken to make sure that issues are collapsed as gently as possible. I don’t believe there is any requirement to re-expose or re-traumatise the trainee so we conduct a “slow approach” to the issue. This starts by visualising a plain white envelope held at arms length and finishes when the trainee can create a mental movie of their trauma and play the movie without any anxiety, emotion or pain. At each step of the way the trainee is asked to identify their SUDS (Subjective Unit of Disturbance or Stress) score on a scale of 0 – 10. Whenever a score of 3 or higher is experienced we conduct a round of TRT to collapse the intensity to a 1 or 0. Initially several rounds of TRT may be required, but as the intervention proceeds one or two rounds are enough. When the trainee states that they are ready to produce their mental movie we conduct a visualisation technique called “the emotional throttle valve” (ETV) which allows the trainee to reduce their own emotional response and take total control of their emotional well being. Once the ETV has been set to zero and secured we produce the movie. The trainee is asked to visualise a control panel consisting of 5 sliders, 3 buttons and a digital meter. The sliders represent taste, touch, smell, volume and colour. All of these are set to zero before creating the movie. The three buttons are play, stop and rewind and are used for playing the movie. The digital meter represents the SUDS score and the rule is made that the trainee must stop the movie the instant the meter reads 3 or higher. The trainee then creates a black and white, silent movie from the position of the movie director i.e. an outside observer, not an actor. Once the movie is created the trainee gives it a title and we then play the movie. As soon as the digital meter hits 3 the movie stops and we conduct a round of TRT for the issue which was identified as the cause of anxiety. The movie is then rewound and the procedure continued until the entire movie can be observed without any idea causing a SUDS of 3 or more. Once this is achieved the trainee is invited to modify the sliders to a position which they are comfortable with and the process is repeated. This continues until the movie can be seen, from the observer position, with all sliders at 100% and a SUDS no higher than 3. The process is now repeated with the trainee visualising themselves as an actor actually participating in the experience. Again the SUDS rule of 3 is invoked and TRT applied until the whole movie can be experienced without anxiety. Once this is achieved the trainee is invited to return to the ETV and open it up to a position which they are comfortable with. I normally suggest only 10% open for the first run through. The full sensory, experiential movie is then repeated and TRT applied as necessary. This process repeats until the trainee is able to re-experience the primary issue, with full emotional involvement and full sensory awareness and no accompanying anxiety. A good indicator that the trainee has finished the process are words like “I’m bored with this – do I have to do it again” or “shit happens – I need to get on with my life”. Once the primary issue has been collapsed, in the case of veterans, four emotions are very quickly experienced in the following order – anger typically at the government, their unit and/or their mates for the sense of abandonment they felt. This is quickly collapsed with more TRT. Immediately after anger, the trainee experiences a sense of guilt – for not protecting/saving their mates or civilians, for living when another person died (possibly perceived as in their place), or for letting down the lads who still have PTSD and have not received help. Again TRT collapses this very quickly. The final two emotions are shame and sadness. These are more nebulous than anger and guilt and so we have found they are not as easy to deal with using TRT because it is often difficult to identify a specific issue. In this case we use a combination of TAT and the Sedona method. This technique quickly dissolves any residual sense of shame or sadness. The final step in the initial intervention is to identify whether the trainee has any incomplete or unresolved communications. These can be with individuals or groups who are living or dead, or even a third party who the trainees feels they need to communicate with. If required, the TRC procedure is conducted. The trainee is brought to a safe, relaxed state and then guided to a place in their head called the waiting room. When they are ready they enter the room and communicate with whoever they find there. In some cases there is no one and nothing is said, in others simple statements are declared and in the final group dialogues are conducted. After this the life map is reviewed and any secondary issues which begin to emerge are identified for future work. If the secondary issue is causing immediate intensity then an intervention is started immediately. At the end of the intervention day everyone, especially the trainer, is tired and typically after a brief chat and selection of sleep aid, everyone takes an early night. On the morning of the third day the sleep quality of the trainees is assessed. The most commonly heard comment is “Wow – I haven’t slept through the night like that in years” or “the demons have gone” or in one case “damn I’ve overslept and missed breakfast!” After this we spend time reviewing and revising the life map and for many trainees suffering from chronic PTSD this is the first time since they developed PTSD that they have been able to look to the future. Once the trainee has come to terms with the idea that he actually has a future to look forward to we start the goal setting process. Trainees are encouraged to identify what they want to be, do or have in the seven key areas of their life – physical, emotional, relational, mental, spiritual, professional and financial. They are also asked to identify their event horizon, how far ahead they can envision their future. We then spend time creating an empowering vision statement which is both attractive and inspiring. So far we have been successful in collapsing all symptoms of long term, late onset, complex PTSD in over 3/4 of all cases. All this work has been conducted under the direct supervision of Major General Dr Robin Short, the former Surgeon General of the British Army. Also we are working with a leading UK charity P3, the social inclusion charity, to create a social enterprise so this can be made available for all ex-servicemen suffering from PTSD. In the next chapter Martin Kinsella, the Chief Executive of P3 will explain what the future holds for the casualties of PTSD and how P3 is spearheading a major charitable drive to provide the much needed relief our veterans need.