Analysis of the body keeps score

[borne_before]

Can't recall the thread, but recent saw The Body Keeps Score being discussed. Here's a book about it.

Analysis of The Body Keeps The Score: The Science That …

Are the claims that psychological stress permanently da…

www.goodreads.com

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[WisNeuro]

Dr. Scheeringa's twitter feed also has a good amount about the pseudoscience and mischaracterizations in TBKTS for those interested.

 

[texanpsychdoc]

Ah...yeah, I remember this book. My previous chief back at another VA I worked at thought it was total BS.

 

[WisNeuro]

Ah...yeah, I remember this book. My previous chief back at another VA I worked at thought it was total BS.

The book that was linked in the OP, or TBKTS?

 

[cara susanna]

Oh man, I would love to read that... although the title is a bit "click bait-y" imo. I'll have to check out the author's twitter for now.

Edit: I love this excerpt from one of his tweets: "I published “Analysis of The Body Keeps the Score” because the system of finding Truth in trauma research is inept."

SO true. The trauma field seems especially susceptible to pseudoscience and quackery.

 

[texanpsychdoc]

The book that was linked in the OP, or TBKTS?

the book...

 

[borne_before]

the book...

I'm confused. Both are books.

Did your supe hate the body keeps score or the analysis of the body keeps score?

 

[R. Matey]

SO true. The trauma field seems especially susceptible to pseudoscience and quackery.

Let me introduce you to neurofeedback...

 

[texanpsychdoc]

I'm confused. Both are books.

Did your supe hate the body keeps score or the analysis of the body keeps score?

I think both?

 

[Fan_of_Meehl]

Let me introduce you to neurofeedback...

This caught my eye. Our chief sent out an email to everyone announcing that our VA hospital would be getting some equipment (but I think it was biofeedback equipment) to use clinically with anxiety patients. I have to admit, I'm not very well versed on the biofeedback literature/practice these days and I'm not familiar with 'neurofeedback' (is it similar to biofeedback?).

I thought biofeedback was at least a reasonably legitimate approach for some clinical scenarios (but most clinicians would have no reason to choose it over a straightforward (cheaper, less bells and whistles) cognitive behavioral approach that doesn't involve any fancy equipment.

I'm just curious as to what this 'neurofeedback' concept is and what people's opinions on it are since this is possibly going to be the next 'great' thing that the VA will be touting as the new sliced bread.

I heard that the brand new clinical practice guidelines (VA/DoD expert consensus guidelines) for PTSD will be published soon.

Not that anyone ever reads those and uses them to design the actual clinical services in VA...

- pushing the hell out of group therapy (which the guidelines say are merely 'better than no treatment at all')
- service dogs
- alpha stim
- acupuncture
- Tai Chi
- drum circles
- you name it

 

[cara susanna]

This caught my eye. Our chief sent out an email to everyone announcing that our VA hospital would be getting some equipment (but I think it was biofeedback equipment) to use clinically with anxiety patients. I have to admit, I'm not very well versed on the biofeedback literature/practice these days and I'm not familiar with 'neurofeedback' (is it similar to biofeedback?).

I thought biofeedback was at least a reasonably legitimate approach for some clinical scenarios (but most clinicians would have no reason to choose it over a straightforward (cheaper, less bells and whistles) cognitive behavioral approach that doesn't involve any fancy equipment.

I'm just curious as to what this 'neurofeedback' concept is and what people's opinions on it are since this is possibly going to be the next 'great' thing that the VA will be touting as the new sliced bread.

I heard that the brand new clinical practice guidelines (VA/DoD expert consensus guidelines) for PTSD will be published soon.

Not that anyone ever reads those and uses them to design the actual clinical services in VA...

- pushing the hell out of group therapy (which the guidelines say are merely 'better than no treatment at all')
- service dogs
- alpha stim
- acupuncture
- Tai Chi
- drum circles
- you name it

There's a NCPTSD seminar next week that I think will review the new guidelines. The major thing I heard is that WET has been downgraded (they were lumping it in with PE previously). The WET people are not happy that it's now lower than EMDR, lol.

 

[R. Matey]

I thought biofeedback was at least a reasonably legitimate approach for some clinical scenarios (but most clinicians would have no reason to choose it over a straightforward (cheaper, less bells and whistles) cognitive behavioral approach that doesn't involve any fancy equipment.

Neurofeedback refers to treating inattention symptoms of ADHD through use of biofeedback-like components (mostly through EEG). There's scant evidence for its efficacy, but it is still widely promoted in some places.

Two sources:

Popular press: Neurofeedback

Scientific review: International Consensus Statement

 

[Fan_of_Meehl]

Neurofeedback refers to treating inattention symptoms of ADHD through use of biofeedback-like components (mostly through EEG). There's scant evidence for its efficacy, but it is still widely promoted in some places.

Two sources:

Popular press: Neurofeedback

Scientific review: International Consensus Statement

Thank you! This is very helpful.

 

[AbnormalPsych]

There's a NCPTSD seminar next week that I think will review the new guidelines. The major thing I heard is that WET has been downgraded (they were lumping it in with PE previously). The WET people are not happy that it's now lower than EMDR, lol.

Please share if you hear some more details!

 

[cara susanna]

Please share if you hear some more details!

Will do!

 

[cara susanna]

Please share if you hear some more details!

Also posted in the VA thread but just in case, here is a quick and dirty summary of the updated (2023) psychotherapy CPG for PTSD:
- Therapy recommended over medication
- Recommended therapies: CPT, PE, and EMDR
- Suggested therapies (lower level of evidence): Cognitive Therapy, WET, and Present-Centered Therapy
- Insufficient evidence for other therapies including but not limited to ART, Adaptive Disclosure, STAIR, CBCT, Seeking Safety, TrIGR, etc
- Individual still recommended over group
- Telehealth video modality is effective, at least for CPT and PE
- Evidence-based therapies work just as well for SUD and complex patients; COPE is recommended for SUD over Seeking Safety

 

[smalltownpsych]

Also posted in the VA thread but just in case, here is a quick and dirty summary of the updated (2023) psychotherapy CPG for PTSD:
- Therapy recommended over medication
- Recommended therapies: CPT, PE, and EMDR
- Suggested therapies (lower level of evidence): Cognitive Therapy, WET, and Present-Centered Therapy
- Insufficient evidence for other therapies including but not limited to ART, Adaptive Disclosure, STAIR, CBCT, Seeking Safety, TrIGR, etc
- Individual still recommended over group
- Telehealth video modality is effective, at least for CPT and PE
- Evidence-based therapies work just as well for SUD and complex patients; COPE is recommended for SUD over Seeking Safety

I wasn’t sure what WET was so googled and the images that came up were interesting. Seriously though, five sessions of written exposure sounds like a part of a treatment more than a whole treatment. I integrate written exposure for any of my patients that like to write.

 

[tr]

Stamp of approval for EMDR huh? Interesting!

 

[WisNeuro]

Stamp of approval for EMDR huh? Interesting!

Well, the exposure piece of it works somewhat. So, there's that.

 

[medium rare]

Well, the exposure piece of it works somewhat. So, there's that.

The exposure component is the only reason it’s beneficial.

 

[cara susanna]

I wasn’t sure what WET was so googled and the images that came up were interesting. Seriously though, five sessions of written exposure sounds like a part of a treatment more than a whole treatment. I integrate written exposure for any of my patients that like to write.

I just got trained in it recently and it's a pretty solid treatment. You just get the ball rolling so to speak. I was skeptical but I saw a HUGE improvement in some of the patients. The interesting thing is people often start decreasing external avoidance on their own. So far, it also has a lower dropout rate than other PTSD EBPs. It definitely is more of a gentle touch. Administering it is weird though, because there is very little interaction with the patient.

The person presenting on the CPG, who was involved with creating them, said that she thinks WET will make it to the highest recommendation list in time. It just is too early and more research is needed.

 

[WisNeuro]

The exposure component is the only reason it’s beneficial.

Oh, I am well aware, this is my secondary specialty area. And the person who trained me in PE is one who did some of the dismantling work in this area.

 

[clausewitz2]

I just got trained in it recently and it's a pretty solid treatment. You just get the ball rolling so to speak. I was skeptical but I saw a HUGE improvement in some of the patients. The interesting thing is people often start decreasing external avoidance on their own. So far, it also has a lower dropout rate than other PTSD EBPs. It definitely is more of a gentle touch. Administering it is weird though, because there is very little interaction with the patient.

The person presenting on the CPG, who was involved with creating them, said that she thinks WET will make it to the highest recommendation list in time. It just is too early and more research is needed.

It's totally one of those interventions that kind of sounds like you are trolling the patient but this has also been my experience implementing it. Hardly a panacea but some people are just way more ready to write extensively about it than talk about things out loud at any length. I think it can also be adapted to telehealth in a fairly natural and straightforward way and loses less than many psychotherapies do from not being in the same room.

 

[chicandtoughness]

Major eye roll at EMDR but I guess it’s gotten to the “if you can’t beat ‘em, join em” stage.

Can someone share more about COPE? I’ve been doing Seeking Safety for years but this is the first time I’ve heard the COPE acronym and wondering if I’m being silly/just know it by another name.

 

[Shiori]

Major eye roll at EMDR but I guess it’s gotten to the “if you can’t beat ‘em, join em” stage.

Can someone share more about COPE? I’ve been doing Seeking Safety for years but this is the first time I’ve heard the COPE acronym and wondering if I’m being silly/just know it by another name.

It's "Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure." It's like if PE and CBT-SUD had a baby.

 

[chicandtoughness]

Oooh. I like PE (a lot) and I like CBT-SUD, will explore this further. Thanks!

 

[Shiori]

Oooh. I like PE (a lot) and I like CBT-SUD, will explore this further. Thanks!

I liked it! I got to do it in SUD-C and the veterans were happy to work on their trauma and substance use at the same time.