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The future of trauma therapy

An expert in PTSD describes why new, non-pharmaceutical therapies have her excited for the future of her field and, especially, for her patients.
Dark room light coming in through an open door
The long term results of cognitive therapies for treating PTSD have made great advances recently. | iStock/bagotaj

Guest Debra Kaysen is a psychologist specializing in treatment of post-traumatic stress disorder (PTSD) who says that promising new cognitive and behavioral therapies are, quite literally, giving people “their lives back.” These therapies work without drugs to help patients manage their disease and its symptoms and, perhaps, even cure PTSD. We’re providing tools to change how they think, Kaysen tells host Russ Altman on this episode of Stanford Engineering’s The Future of Everything podcast.

For anyone interested, Kaysen offers a list of PTSD resources:


Free apps from the VA for PTSD and other related concerns

For a Cognitive Processing Therapy (CPT) trained therapist

Stanford’s PTSD clinic

International resource for a Prolonged Exposure (PE) trained therapist

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[00:00:00] Russ Altman: Hi everyone. We've got a good episode today on The Future of Trauma Therapy. Before I get into my conversation with Debra Kaysen, a professor of psychiatry and behavioral science at Stanford University, I wanna share that if you are looking for support after trauma, we are listing a number of resources in the summary that accompanies this episode, and also in this week's show notes.

Please don't hesitate to use these resources or to share them with someone in your life who could benefit from them.

[00:00:27] Debra Kaysen: I've been doing this for a long time [00:00:30] and I am still as excited about this field as I was as a second year grad student because this is a place where you can watch people get their futures back and their lives back in short periods of time.

[00:00:48] Russ Altman: This is Stanford Engineering's The Future of Everything podcast, and I'm your host, Russ Altman. If you enjoy the future of everything, please follow or subscribe wherever you get your podcasts. This will guarantee that [00:01:00] you never miss an episode and you'll never be surprised by the future of anything.

Today, Debra Kaysen will tell us how cognitive therapies for post-traumatic stress disorder or PTSD have made great advances recently. They're leading to shorter treatments and really great long-term outcomes. It's The Future of Trauma Therapy.

Post-traumatic stress disorder, or PTSD is a clinical diagnosis that sometimes follows extremely [00:01:30] traumatic experiences and leads to disabling symptoms. PTSD can arise across all cultures settings and to people who experience combat, sexual abuse, torture, domestic violence, and other traumas. While there are some drugs to treat PTSD, there's also growing capabilities for cognitive therapies to help patients understand and manage their disease and their symptoms, and even cure PTSD.

Professor Debra [00:02:00] Kaysen is at Stanford University in the Department of Psychiatry and Behavioral Sciences. She studies cognitive therapies for PTSD in different populations, settings, and as the result of different types of trauma. She has studied the intersection of PTSD and other diseases and has looked at the long-term results of cognitive therapies, and she'll tell us that they're looking pretty good.

Debra , Can we start with a definition of some basic terms like stress, trauma, and post-traumatic [00:02:30] stress disorder? I know there's some confusion in the lay public about this.

[00:02:34] Debra Kaysen: Absolutely, and I'm so glad that you bring this up because I have so many people who come to me and they'll say, I had a trauma, and what they're talking about might fit a dictionary definition of trauma, but it doesn't mean the same thing as the kinds of events I work on.

So when you think about stress, we all experience stress. Stress means that we've experienced a change and our body and our physiology [00:03:00] changes in result to that.

[00:03:01] Russ Altman: Yes.

[00:03:01] Debra Kaysen: It can be good events, it can be bad events. Ever Take a new job, have a baby, take on a new challenge at work. Those are all stressors and our body reacts to that.

A trauma, when you look at the dictionary is anything that causes distress.

[00:03:21] Russ Altman: Mm-hmm.

[00:03:21] Debra Kaysen: Now, when I talk about a trauma, I'm talking about a really specific kind of event that we talk about in the mental health [00:03:30] field. And for those events, those are events where you may, um, experience physical violence, uh, sexual violence, a death. It could happen to you, you could witness it, it could happen to someone that you love very much. And the reason we make that distinction between stress, which are normal events,

[00:03:54] Russ Altman: Yep.

[00:03:55] Debra Kaysen: Trauma in the dictionary. And these kinds of what we call CRIT [00:04:00] A, Criterion A traumatic events is because it's really only that third category that has a higher likelihood of leading to post-traumatic stress disorder.

[00:04:10] Russ Altman: Okay, great. That was very helpful. And I know that you study the different occurrence of these traumatic events, uh, and the response to it, and so, In different cultures, different people, different settings of the trauma. So to what degree is, um, is it in the eyes of the beholder? In other words, could two people go through the exact same [00:04:30] experience?

One person, you would look at them and say, okay, that was a stressor, but I'm talking about stress. Where in another person you say, okay, that was a trauma. That's something that I'm worried about. A future development of post-traumatic stress.

[00:04:41] Debra Kaysen: Yeah.

[00:04:41] Russ Altman: How much variability is there across individuals?

[00:04:45] Debra Kaysen: Oh a ton.

[00:04:45] Russ Altman: Okay.

[00:04:46] Debra Kaysen: So, and I love that you're asking about the eye of the beholder. So I'll give you a personal example. When I was in my twenties, my partner and I went to go grocery shopping and we [00:05:00] had someone who pulled a knife on us. We were shopping super late. I had a job that let out late. It was like 11 o'clock.

We're in the Safeway parking lot. Guy pulls a knife out on us.

[00:05:09] Russ Altman: Wow.

[00:05:10] Debra Kaysen: Okay. For me, That would've been a Criterion A trauma. I was super scared and my spouse walked back into the building to let them know that there was some guy with a knife who was attempting to mug people, and I was absolutely sure that my partner was gonna get stabbed.

So for me, I had high [00:05:30] physiological arousal. I interpreted this as a potential threat of violence or loss of life.

[00:05:39] Russ Altman: All right.

[00:05:40] Debra Kaysen: For my partner, he was like, eh, the guy was not gonna do anything with it.

[00:05:46] Russ Altman: Right.

[00:05:46] Debra Kaysen: I looked at that knife, he wasn't gonna there, there I was.

[00:05:49] Russ Altman: There was no risk. So that is a great example cuz you went under the exact same experience and

[00:05:54] Debra Kaysen: Correct.

[00:05:54] Russ Altman: Diametrically uh, different responses.

[00:05:57] Debra Kaysen: Exactly. So, the way you [00:06:00] interpret the situation, It plays a huge role in your risk for psychological injury from that.

[00:06:07] Russ Altman: Okay, so let's go to PTSD, which is a lot of people hear about PTSD I think it came up in a lot of the public consciousness. Um, you know, it's been, people have talked about it World, world War I and World War II, but I know that in my generation at least, it was the re. People returning from Vietnam was a very common.

[00:06:25] Debra Kaysen: Yes.

[00:06:25] Russ Altman: But in looking at your work, it's obvious that this is a much more general phenomenon than [00:06:30] having experienced the battlefield. And so when does this traumatic experience turn into PTSD as a diagnosis and then

[00:06:38] Debra Kaysen: Right.

[00:06:39] Russ Altman: Maybe give us a little bit about how common this is and how much of a risk it is in the population these days?

[00:06:46] Debra Kaysen: Absolutely. So trauma exposure, even those big traumas are actually pretty common. So, If you look at the epidemiological data, anywhere from 70 to 90% of Americans have experienced at [00:07:00] least one of those kinds of events. Yeah. Thankfully, PTSD is actually not that common. So, uh, let me talk about how often you see it, and then let me explain what it is.

[00:07:13] Russ Altman: Sure.

[00:07:13] Debra Kaysen: So in terms of PTSD what we see is about 10% of people develop PTSD. So, And it depends on the kind of trauma that you experienced. So some kinds of events have relatively low risk, uh, [00:07:30] motor vehicle accidents. Um, natural disasters actually have lower risk of PTSD.

[00:07:36] Russ Altman: Yeah.

[00:07:37] Debra Kaysen: When we move into things where the harm is intentional. Where the harm is done by somebody that you trust, then we get to much higher risk levels for PTSD. So events like sexual assault, intimate partner violence, Uh, combat. Those are events that tend to have much higher risk [00:08:00] associated with that.

[00:08:01] Russ Altman: Okay.

Symptoms, signs? How does somebody know that they or their mean or their provider?


[00:08:07] Debra Kaysen: Exactly. What does this mean? I mean, it's just like word salad. That doesn't mean anything.

[00:08:11] Russ Altman: We already have four letters.

[00:08:13] Debra Kaysen: Absolutely. So post-traumatic stress disorder has a number of symptoms that go along with it, and they're in clusters. So the first cluster of symptoms are what are called intrusive symptoms.

And you can almost think about it like that memory of the trauma keeps [00:08:30] coming up in ways that you don't want. So those are things like nightmares. Memories that pop into your head getting super upset when something reminds you of that traumatic event. Um, the one that people think about, like if you look at the movies and TVs or flashbacks

[00:08:47] Russ Altman: Yes.

[00:08:47] Debra Kaysen: Which is a memory that's so vivid that you're stuck in it. It's actually a pretty uncommon symptom, but it would fit in that class.

[00:08:53] Russ Altman: And it's certainly evocative. I mean, it's striking when you...

[00:08:56] Debra Kaysen: yeah.

[00:08:56] Russ Altman: ...hear about this.

[00:08:57] Debra Kaysen: Absolutely. Now, the next cluster of symptoms are [00:09:00] what are called avoidance symptoms. And those are things like trying to avoid anything that reminds you of it.

Avoiding places, people conversations, but it can also be avoiding feelings about the trauma, avoiding physiological cues that bring up that reminder of the trauma. Um, not going to, um, if I all of a sudden stopped going to that Safeway parking lot.

[00:09:26] Russ Altman: Yes. Yes. So this begins to be a functional, a blocking [00:09:30] of your normal, functional life.

[00:09:31] Debra Kaysen: Exactly. And that's where. PTSD starts stealing people's lives. As that avoidance, your life gets smaller and smaller as you try to avoid anything that reminds you of that event, including things that are safe or neutral.

[00:09:46] Russ Altman: Yeah. Yep.

[00:09:46] Debra Kaysen: So then the next cluster of symptoms are changes in your mood and your way of seeing the world. And again, this is where PTSD is so devastating and really steals from people. So it all of a sudden you may [00:10:00] have much stronger negative emotions, guilt, shame, anger, disgust.

You may find that your normal emotions are numb. Often loving, um, happy feelings may be completely shut out.

[00:10:16] Russ Altman: Huh.

[00:10:16] Debra Kaysen: Um, I had one client who told me that, you know, her grandchild would climb in her lap and she would know that she should feel loving, but it was just completely blocked. She said it felt like her insides were stuffed with cotton.

You may see the [00:10:30] event as something that you're responsible for or you're to blame, even though an outside observer would say, you know, how could that be your fault? Okay, Ann, you may start seeing the world through a negative lens. I almost think about like turn, putting on really dark sunglasses and that's how you're now seeing world

[00:10:48] Russ Altman: The opposite of the rosy sunglasses.

[00:10:50] Debra Kaysen: Yes, that's exactly right. It's the PTSD dark shades, right? So it's, um, the world is unsafe. I can't trust [00:11:00] anyone. Um, I'm damaged, I'm broken. So you're gonna see yourself, other people in the world in these really negative shades. Um, and then the last cluster are what are known as hyper arousal symptoms. So those are things like startling really easily.

[00:11:17] Russ Altman: Mm-hmm.

[00:11:18] Debra Kaysen: Feeling like you have to be watchful and on guard all the time, not being able to sleep, not being able to concentrate. So when you look at that whole package, you can really [00:11:30] see how this disorder can destroy lives.

[00:11:33] Russ Altman: Yes. Okay. So that is a sobering picture of what's obviously a very disabling, uh, disorder.

I know you have focused on treatment and the treatment is exciting because it does involve some drugs, I think, but it's also involves a lot of things you've look, been looking into in terms of internet, telephone, long, short. So give, can you give us the landscape of treatment for PTSD these days, [00:12:00] especially from your perspective, the exciting parts of it these days?

[00:12:04] Debra Kaysen: Yeah. So, you know, back in the dark ages when I was in grad school, um, you know, we really thought that you couldn't cure PTSD. Um, not in my graduate program cuz that's actually grad program I picked. But for a lot of people, like I had one patient where she worked in the mental health field and she was told she needed to drop out cuz she had PTSD.

[00:12:25] Russ Altman: Mm.

[00:12:25] Debra Kaysen: Um, and instead we got her good treatment. So here is [00:12:30] why I've been doing this for a long time and I am still as excited about this field as I was as a second year grad student. Because this is a place where you can watch people get their futures back and their lives back in short periods of time.

So treatments for PTSD fall into kind of two. I'm gonna put the meds aside for one sec.

[00:12:52] Russ Altman: Okay, sure.

[00:12:52] Debra Kaysen: Two major, and we can come back to them, but two major categories, what are called cognitive therapies, which is changing [00:13:00] how people think tea, giving them tools to shift those beliefs about why the trauma happened and what it means now.

So taking off the, the dark shades, not putting on rose-colored glasses. Actually we're

[00:13:14] Russ Altman: we're taking off our dark shades.

[00:13:15] Debra Kaysen: We're taking off our glasses. Exactly. So that's what the cognitive therapies do. Okay, so we look at the story that the person told about the trauma, and the therapist uses a really old skillset, Socratic [00:13:30] dialogue to help the person learn how to evaluate for themselves whether that narrative is true or not, and to change it to be more realistic and balanced.

[00:13:40] Russ Altman: Yes.

[00:13:41] Debra Kaysen: The other therapy directly tackles that avoidance piece, and those are what are called exposure therapies.

[00:13:47] Russ Altman: Mm-hmm.

[00:13:48] Debra Kaysen: What those do is they help the person learn that the memory and the cues about the trauma are not actually harmful. They're painful, but they won't hurt you. Best [00:14:00] analogy I can think of is if you've ever gotten on a rollercoaster, I'm not sure how you feel about rollercoasters. I'm super excited about them.

[00:14:07] Russ Altman: My feelings have changed with age. Let's just leave it at that.

[00:14:10] Debra Kaysen: Yeah, that too. Yeah, that too. Um, I'm, the person who gets in the line is excited, gets halfway through the line and feels dread, gets in the thing and goes, what have I done to myself? And then wants to get out.

[00:14:22] Russ Altman: Yes.

[00:14:22] Debra Kaysen: Right. Okay. Now, if I got on that same rollercoaster a hundred times by the hundredth time, [00:14:30] I probably wouldn't be having those reactions anymore. I would mostly be feeling the excitement about it and that fear would come down. That's the principle of exposure therapy.

[00:14:40] Russ Altman: I'm fascinated by exposure therapy, cuz I know looking at some of your work that you've talked about, both written and narrative exposure.

So I wonder if I could just ask you real quick, what are those, because it sounds like they must be,

[00:14:50] Debra Kaysen: what are those,

[00:14:51] Russ Altman: a type of anticipating the, uh, rollercoaster ride?

[00:14:54] Debra Kaysen: Absolutely. Then there's actually three.

[00:14:56] Russ Altman: Okay.

[00:14:56] Debra Kaysen: So those two are newer in many ways. So the workhorse [00:15:00] of the PTSD field is a therapy called prolonged exposure. It has been tested all over the world. It is a beautiful, elegant, and very effective therapy, and there have been probably at this point hundreds of trials looking at it. It does two things, it does what's called in vivo exposure, which is just a fancy way of saying exposure in real life to trauma cues that are not actually dangerous. Over and over again until they get boring.

[00:15:28] Russ Altman: Mm-hmm.

[00:15:29] Debra Kaysen: [00:15:30] And imaginal exposure, which is exposure over and over again to the trauma memory in the presence of the therapist until that story becomes tolerable.

[00:15:40] Russ Altman: I can imagine both of those being very difficult to get started.

[00:15:45] Debra Kaysen: Yes. Um, and the job of the therapist is create a safe

[00:15:50] Russ Altman: Yeah.

[00:15:50] Debra Kaysen: Place where someone can do that work. And also to be a cheerleader honestly. Um, and to really believe in the person's ability to make change [00:16:00] now. Written exposure therapy. So prolonged exposure usually is about six to 18 sessions.

[00:16:06] Russ Altman: Okay.

[00:16:06] Debra Kaysen: So still pretty quick.

[00:16:07] Russ Altman: Yeah.

[00:16:08] Debra Kaysen: Okay. Written exposure therapy, I'm very excited about because with that therapy, so the one downside around prolonged exposure is there's a fair amount of work that has to happen on the client's part between sessions.

So they listen to the memory over and over again, and they do the in vivo exposure in their [00:16:30] lives over and over again. For some folks, that's just too hard.

[00:16:33] Russ Altman: Mm-hmm, mm-hmm.

[00:16:34] Debra Kaysen: For whatever reason, you know, if I'm working two jobs and I got kids, when am I gonna find that time?

[00:16:40] Russ Altman: Right. Right.

[00:16:41] Debra Kaysen: Written exposure therapy is five sessions. All of the work, the practice is done with the therapy with the therapist in the room. There's no practice between sessions and it has equal effects to some of the leading PTSD therapies that are much longer, quite [00:17:00] so long.

[00:17:00] Russ Altman: And so are they actually writing about their experience? And uh, and but they're doing it in the presence of the, uh, therapist.

[00:17:06] Debra Kaysen: Therapist.

Yep. So what happens in that therapy, again, very straightforward in many ways that doesn't make it easy to do, um, is they write the narrative of what happened. The therapist reads it between sessions and then gives them feedback about how to titrate how to get into the memory slightly more effectively.[00:17:30]

[00:17:30] Russ Altman: Yeah.

[00:17:31] Debra Kaysen: And then they rewrite it, taking into account that feedback, the therapist, spend some time with them at the end making, you know, talking about what they learned. And that's what you do, rinse and repeat five sessions.

[00:17:43] Russ Altman: And there's no homework for the patient.

[00:17:46] Debra Kaysen: So the homework is try not to avoid in your day-to-day life, if the memories and feelings come up, don't push them away.

[00:17:52] Russ Altman: Right.

[00:17:53] Debra Kaysen: Yeah, but no listening to the memory, no worksheets. Those things that can take up time when folks have [00:18:00] things that they need to be doing in their lives.

[00:18:02] Russ Altman: So before we go to the break, I definitely want to hear about the third type of exposure therapy.

[00:18:06] Debra Kaysen: Yep, you got it.

[00:18:08] Russ Altman: And that would be narrative,

[00:18:09] Debra Kaysen: narrative exposure therapy.

[00:18:11] Russ Altman: So how does that work?

[00:18:12] Debra Kaysen: So narrative exposure therapy was developed to, uh, by some researchers in Germany and in the Netherlands, and it was specifically designed for low and middle income countries. And so it's a slightly different model and it brings together psychoanalytic theory, [00:18:30] theories of behavior therapy, and what's called testimonial therapy. And it was developed for South Africa in response to apartheid.

[00:18:38] Russ Altman: Yes.

[00:18:38] Debra Kaysen: And it was also used in Rwanda following the Rwandan genocide. What's interesting about that therapy, it has a tactile element, meaning that the therapist and the client together lay a lifeline of the person's entire life with using natural elements, often stones and flowers to represent [00:19:00] positive life events and traumatic events.

And then they do exposure to each trauma one by one rather than one trauma over and over again. But it helps put the whole life into a perspective and it helps the person with the same things tolerating the memories. Looking at the story you've told yourself about what's happened, but in this case, you're putting it through someone's entire lifeline.

So we're testing this with a [00:19:30] tribe of Native Americans, where it's been a really beautiful cultural fit, both in terms of the emphasis on oral storytelling and the tactile real world elements that are woven into the therapy.

[00:19:44] Russ Altman: This is The Future of Everything with Russ Altman, more with Debra Kaysen next.

Welcome back to The Future of Everything. I'm Russ Altman and I'm speaking with Professor Debra Kaysen of [00:20:00] Stanford University.

In the last segment, Debra told us about the symptoms of PTSD and how cognitive therapies can be very effective. These include exposure therapies where through writing narrative or simple repetition and re-exposure, patients can achieve effective remission and even cure.

In this segment, Debra will tell us that some of the treatments are getting faster and more intense. She'll also tell us that the long-term outcomes over 10 years are [00:20:30] very good.

So Deborah, for this uh, segment, I first wanted to ask you about the time it takes to get an effective treatment. You talked about how um, some of the exposure therapies are a lot of work and take a long time, multiple sessions. And then you talked about some of the ex writing. I think writing exposure was a few less sessions. Um, you know, in this era of like, let's do it fast. Is there any hope for actually trying to get people back on their feet or at least substantially treated in shorter amounts of time?

[00:20:59] Debra Kaysen: [00:21:00] Yeah, so sometimes, you know, if you're having therapy last for months, like let's say four months, right? CPT is a therapy I use a lot kind of processing therapy takes four months. The problem is a lot of life chaos can happen in four months. Yeah. Right now people are doing what's called mass treatments.

So what that means is you go into therapy daily, maybe twice a day, and you can condense all the work of these therapies into a week, two weeks. So for someone who, for [00:21:30] example, um, you are on break, you're gonna take a week off work, you could have your PTSD treated in a week.

[00:21:38] Russ Altman: And are those outcomes any good?

[00:21:40] Debra Kaysen: Yeah. In fact, what's so exciting is the outcomes are better. They're at least as good, if not better, going out to, let's say six months. And I'm gonna talk about long-term outcomes. I wanna tell you cuz that this to me is so exciting in general, but when we look at those therapies, [00:22:00] dropout is lower. People are more likely to finish and they get at least as good of an outcome.

Um, if you wanna hear what it sounds like, I actually was on this American Life on 10. There was an episode called 10 Sessions, and you can actually hear what one of these therapies sounds like. The journalist who allowed her story to be told. Um, came to Seattle, which is where I worked then, and we did treatment in two weeks.

[00:22:25] Russ Altman: So can you paint a picture, uh, a picture of like what happens in [00:22:30] that it sounds like PTSD Boost Bootcamp basically.

[00:22:33] Debra Kaysen: Yes, exactly.

[00:22:34] Russ Altman: Um, what happens, what are the highlights of that week?

[00:22:36] Debra Kaysen: So what you're doing is you're getting this intensive dosing of the practice itself. So if it's a therapy like cognitive processing therapy or prolonged exposure where there's practice, you're doing that practice every day, but you're much more likely to keep motivation when you've got it condensed in that way. And it seems like for people, the learning really stays with them during that time. So you would do [00:23:00] the same amount of practice or close. You just do it in a much more concentrated format. And so it gives the avoidance less time to sneak back in.

[00:23:11] Russ Altman: Yep.

[00:23:12] Debra Kaysen: And you get more therapist support, cuz we're with you every day.

[00:23:15] Russ Altman: Yeah. We, we've seen this in education as well, that sometimes students say, don't teach me a course, give me a four day intense experience.

[00:23:22] Debra Kaysen: Yeah.

[00:23:22] Russ Altman: This seems to be a human preference in many settings.

[00:23:25] Debra Kaysen: Exactly, and I, you know, I've treated some folks who worked for airlines, for [00:23:30] example, and one of the challenges is they would, you know, get off of their period of, uh, medical leave and they'd have to get back to work and I'd lose 'em from therapy because their schedules are so chaotic. Right.

If I could have done that, I could have gotten 'em all the way better.

[00:23:45] Russ Altman: So another novel therapy that I know you work on, and I definitely wanted to hit upon was

[00:23:50] Debra Kaysen: mm-hmm.

[00:23:50] Russ Altman: Sometimes people can't even be physically present just because of their life.

[00:23:53] Debra Kaysen: Correct.

[00:23:54] Russ Altman: You might need to use a telephone, an internet, I don't know, an app.

Uh, what's the status? Is that, are those [00:24:00] serious contenders these days?

[00:24:01] Debra Kaysen: Absolutely. Absolutely. We've got some really promising developments in that area. And again, you know, one of the populations that I care a ton about are sexual assault survivors. It's really hard for people to find a therapist in the first few weeks after a trauma, and it's really hard to find people that you can talk to.

So one of the places where we've been looking at digital mental health are apps that sexual assault survivors could access [00:24:30] within the first, say, weeks, months after traumatic event.

Telehealth for PTSD is actually not novel anymore.

[00:24:37] Russ Altman: Huh.

[00:24:37] Debra Kaysen: We've been doing it for a long time. It works just as well as in person. Um, in fact, I see most of my patients via telehealth.

[00:24:44] Russ Altman: You know, for

[00:24:45] Debra Kaysen: other,

[00:24:45] Russ Altman: for,

[00:24:46] Debra Kaysen: Yeah. Go ahead.

[00:24:46] Russ Altman: For some of those survivors, as I'm still thinking about the survivors of sexual abuse, that there might be a comfort with, uh, being with an app. I, there's, I know that there's been some literature on, sometimes people are more honest on their [00:25:00] computer because some of the barriers of honest communication breakdown. Do you see that in this case?

[00:25:06] Debra Kaysen: I don't know about honesty per say, but I do think that it breaks down that fear of being judged.

[00:25:11] Russ Altman: Yes. That's a better way to put it.

[00:25:13] Debra Kaysen: Yeah. The other piece that's exciting is a colleague of mine who's also at Stanford has been doing some wonderful work looking at can we treat PTSD with text messages?

So asynchronous therapy. So you're still working with a person, it's not a chat bot. [00:25:30]

[00:25:30] Russ Altman: Right.

[00:25:30] Debra Kaysen: But talk about accessibility, right? I'm having a thought right now. What do I do?

So I think those are some directions that I'm seeing the field move in terms of does it work? So, um, yeah, these therapies do seem to work, especially for the people who stick with them.

[00:25:49] Russ Altman: Yes. That's amazing. So, uh, but I wanted to ask about, I guess, two related issues, the long-term outcomes for folks. I mean, you started our discussion saying, yeah, you went to graduate school, [00:26:00] and the predominant feeling was this is not a curable disease and we've moved away from that.

So just myself as a physician, I know that the two issues are, uh, the long-term out, like how long is the cure? And, and related to that is, um, whatever the word is for a recurrence of symptoms. So where are we and, and how are things looking in terms of those long-term perspectives?

[00:26:22] Debra Kaysen: So in a lot of the psychotherapy research, we don't have long-term outcomes, PTSD is different. So we have done, uh, actually my grad school [00:26:30] mentor did a study where she looked at those two leading therapies, CPT and PE.

She followed women following a sexual assault. 10 or more years after they finished six weeks of psychotherapy, folks looked basically the same at that 10 year mark as they did at the moment that they finished therapy. And for that therapy, 80% of the people lost their PTSD diagnosis.

[00:26:57] Russ Altman: So that's a humongously good [00:27:00] outcome.

[00:27:00] Debra Kaysen: Yeah.

[00:27:00] Russ Altman: There are many diseases, uh, that do not have anything close to that kind of level of, uh, long-term remission, let's call it remission.

[00:27:08] Debra Kaysen: Remission, right. We did a study in the Democratic Republic of Congo, again with sexual assault survivors, and this is a place where the rates of sexual assault are very high.

We tested cognitive processing therapy there and did a seven year follow-up study, and even in a setting where re-victimization was extremely common, [00:27:30] 50% of women stayed basically below a clinical threshold in terms of symptoms.

[00:27:37] Russ Altman: So, that actually, um, I wasn't planning on asking this, but that makes me wonder, does successfully completing the treatment for a prior trauma help you kind of deal with future traumas?

[00:27:49] Debra Kaysen: Yes. So this is a place where treatment can be prevention. We found that people who go through these therapies are actually less likely to get re-trauma [00:28:00] exposed. And if they are re-exposed, are more likely to be resilient.

[00:28:05] Russ Altman: So you're basically giving them, uh, skills for the rest of their lives.

[00:28:09] Debra Kaysen: That's exactly right.

[00:28:11] Russ Altman: Thanks to Debra Kaysen. That was The Future of Trauma Therapy. You have been listening to The Future of Everything podcast with Russ Altman. If you enjoy the podcast, please consider subscribing or following it so that you'll receive news of new episodes and never be surprised, maybe tell your friends about it.

And definitely rate and [00:28:30] review that will help us get better. We have more than 200 episodes in the archive, so go check them out and see if there's something about The Future of Everything that we talked about in the past. You can connect with me on Twitter @RBAltman or with Stanford Engineering @StanfordEng.