Many or most therapies to address combat related CPTSD (Chronic Post Traumatic Stress Disorder) have shown less than satisfactory results, particularly if you ask the veteran rather than the practitioner. CPT (Cognitive Processing Therapy) and CBT (Cognitive Behavioral Therapy) have not shown to be clinically effective therapies for PTSD particularly if measured over time and looking at the high percentages that PTSD remains as an active clinical diagnosis. In addition, other therapies such as EMDR for PTSD also show meager results again if measure over significant time frames.
The Trauma-Stress Model Leading to PTSD
In the absence of significant trauma or stress, PTSD is rarely found. The myriad of trauma’s found in military life can set off a long and extremely dangerous chain reaction within the brain and body. Since suicide rates are approximately 25 per day in the U.S., we consider this statistic extremely dangerous as to its lethality to our veterans. And unfortunately, this rate is likely to be much higher because only some states even report these suicides.
As we shall see the nature of the trauma has little bearing on the emergence of PTSD. Rather it is the pure intensity of the experiences that seem the greatest provocateur, not the type such as whether it is emotional, physical, witnessed, participating in, or observer of trauma(s) seems to have no influence on the physical changes that occur in the brain such as hyperactivity of the limbic system of the brain which will develop a hyper-focus on the mental and physical pain elements from the trauma, to the exclusion of other thinking. It will purposefully exclude reasonable evaluation of the trauma in preference for highly irrational and painful responses to the trauma.
The false assumption in the understanding of these traumas and how the body-brain reacts is the fact that the changes (responses) on the purely physical level are permanent and very specific. If you want a specific symptom to return to normal – such as “intrusive thoughts or memories” the mechanisms that support returning back to pre-trauma states such as respiration does not occur. In other words, normal breathing sets the stage for normal thinking. To think we can return to normal thinking by talk therapy alone which doesn’t reset respiration is a untenable result as it ignores human physiology. This could be an underlying cause for talk therapy failure.
For example, the breathing system reacts to trauma in a universal manner: it alters its brain ‘software’ that controls the respiration. The alteration has been assumed to ‘recover’ but these authors find zero evidence so far that the persons suffering from PTSD have recovered by measuring respiration rates (RR) and control pause (CO2) measures which accurately indicate breathing state efficiency. They have 2 distinct breathing malfunctions known as “paradoxical” – a term coined by Travel and “pendulum” – a term coined by Rubenstein breathing types. (Both will be elucidated later in the breathing section of this paper).
The assumption has traditionally been that these respiration issues return to pre-trauma readings after some time has passed. Again, we find consistent breathing errors in nearly every PTSD sufferer. These breathing errors are elevated breathing rate, non-rhythmic breathing, sighing, mouth breathing, a strong recoil at exhalation, a pause at the top of an inhale, an exaggerated crescendo inhale, chest breathing to the exclusion of diaphragmatic breathing, shallow and/or rapid chest breathing, and a secondary inhale. These breathing errors can be found in other traumatized populations that show what we might refer to as civilian PTSD also.
Our
trauma model provides an observed set of responses that we find to be reflexes
meaning that there is no element in which conscious decision is involved in
said reactions making them reflexes. This distinction places all reactions
firmly in a new category – that of truly outside the soldier’s ability to
modify in any way their reactions.
The Stress Cycle Begins
The first reflexive reaction to trauma is to the respiration center in the brain. This is the beginning of a long chain-reaction of elements leading to the onset of PTSD. It, the pneumotaxic region of the respiratory center in the brain immediately switches to non-diaphragmatic breathing and dramatically increases chest-driven breathing up to seven times normal breathing volume instantly. The assumption has been that such respiratory mechanics return to pre-trauma types in speed (breaths per minute) and type (chest vs. diaphragmatic). This is demonstrably false. In addition, it is likely that most soldiers lack proper breathing mechanics not to mention idealized respiration prior to enlistment. It is reasonable to assume that most persons have had at least one significant trauma in their early childhood between ages 2-8 as this seems ubiquitous in the population. Therefore, the trauma experienced in the military serves to supplant abnormal respiratory measures markedly and deeply such that a concretized or deeply embedded maladaptive breathing function is realized.
The chest becomes the sole breathing mechanism resulting in low-grade but
constant de-oxygenation of the entire system also known as “hypoxia.” This is
not hypoxia that is severe enough to be noticed by medically trained
professionals as they only react to breathing that is severe enough in its
presentation as to be ‘immediately requiring attention.’ This breathing
issue is more subtle and treacherous because it is not noticed, and it is with
the soldier 24/7. It leads to pervasive anxiety and low brain dominance.
The Stress Cycle Repeats:
Retriggered Paradoxical and Pendulum Breathing Becomes More Embedded
Completing the cycle here is the retriggering of the initial symptoms of rapid shallow breathing and its many sub-variants. This is the original reflexive reaction triggered by all trauma. The FFFF is reignited again and again increasing the suffering and hopelessness of the combat vet to partake in a normal life, as they would define it.
This is patently unacceptable particularly as it is NOT necessary suffering due to the development of ways and means to trigger the exact opposite reflex – the Relaxation Reflex. This Reflex has every bit the voracity and speed of animation or activation that the Stress Reflexes have. The Stress Cycle above illustrates the basic events in the sequence as they happen within the physiology as we know it to unfold. This author finds very little evidence that the Stress Cycle stages, or sequence is in dispute.
Stress has a Structure
In order to produce a model to understand stress and to quantify it we sought to look for some type of equation or calculus to provide a meaningful basis of predictability and correlations such that clarity of certain symptoms would disclose and accurately predict outcomes. Such a model follows.
Stressors are not Stress
First, it is clearly demonstrable that control over the stressors, simply does not exist. For example, the soldier cannot control the fact that wars happen nor can they control their absolute role in it. Other stressors are money, relationships, world events, health issues, and more. We find no appreciable ability to control these elements, but they exist fundamentally in our lives. So, they exist and must exist, but we cannot have any meaningful vote on their potential to provoke the FFFF.
But when it comes to the stress reflexes there exists a window of opportunity to alter their pathway dramatically. Let’s examine the stress reflexes as a group from now and elucidate in great detail later in this paper their roles in brain and body.
Treatment
It is accurate to describe the Program of treatment herein as one in which the reflexes of stress are reversed into the reflexes of relaxation. The Rubenstein Method seeks to use a specific sequence of treatments which essentially stop sympathetic dominance and replace it with parasympathetic.
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