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Reactivation of PTSD Symptoms Resulting From Sandy Hook Media Exposure: Page 2 of 2

Reactivation of PTSD Symptoms Resulting From Sandy Hook Media Exposure: Page 2 of 2

Although there has been little written about empathy as a risk factor for PTSD, some research supports the connection between empathy and symptoms of traumatic stress.9 Empathy may lead to PTSD-related symptoms, including survivor guilt and feelings of helplessness in veterans who are prone to moral injury. These individuals are deeply affected by the sufferings of others. It may prove worthwhile to further explore empathy as a risk factor for PTSD symptoms in the subpopulation of veterans who are likely to have moral injury from their combat experiences.

While Robert’s reaction suggests a link to previous moral injury, it should be noted that other sequelae are also possible. A discussion with other counselors in our program indicated that some veterans with preexisting PTSD also reacted strongly to the Sandy Hook shootings; however, their PTSD pathologies emphasized issues of safety. Based on their experiences in combat, this group viewed the world more as an unsafe place in which they had to be constantly on guard for signs of danger. Perceiving the world as full of danger, they feared that the response of society would lead to gun restrictions, which would further curtail their ability to protect themselves.

Treatment implications
Neria and Sullivan10 suggest that future research to examine the role of fear conditioning and fear extinction models might shed light on the development of symptoms among individuals indirectly exposed to mass trauma. While this might be a fruitful avenue of research for some veterans who respond to trauma in a more fearful manner, the above case suggests that those with a history of trauma related to moral injury might benefit from another approach.

Traditional PE treatments for PTSD may not be enough to heal the wounds of moral injury. Although PE therapy is considered the gold standard for PTSD treatment, not everyone benefits equally. There is a substantial dropout rate for existing PTSD treatments, including PE therapy, and it may be that a certain proportion of individuals who drop out do so because they believe they are not benefiting—or are even getting worse—from the therapy.11 Further, the National Center for PTSD argues that traditional therapies may not be sufficient to heal moral injuries of war, especially killing-based transgressions.12

Litz and colleagues13 are piloting a new approach that specifically addresses the moral injuries of combat. This approach, described as “moral repair,” has shown some success, but has not yet been adopted in general practice. For the time being, PTSD treatment (eg, PE therapy, cognitive processing therapy) can be tailored for patients who have suffered a moral injury. Strategies such as reparation and forgiveness, which are components of moral repair, along with attempts to foster resilience and posttraumatic growth can be incorporated into treatment.7

While standard treatments utilizing psychological and psychiatric modalities are useful approaches to treating symptoms of PTSD, helping or encouraging patients to access their creativity may be another path to healing, and therapists can use positive reinforcement to support their patients with such an individualized approach. For example, writing about traumatic experiences can be an effective treatment for PTSD and can ease a variety of symptoms, including feelings of shame and guilt.14

Several weeks after Robert called his therapist in distress, he indicated he was feeling better because immersed himself in writing poetry. He had written poems specifically about the Sandy Hook shooting. One of his poems, titled “The Pistol-packin’ Boogyman,” read in part, “My Lai comes to Connecticut . . . God invites them (the children) to sit in a reading circle . . . He touches the bullet holes in their heads . . . In their hearts . . . and their wounds fly away.” Robert said that through his poetry, he felt he “won back part of my soul because I chose to feel, I chose to be human.”

Although it may be unpleasant to revisit the original trauma in light of a new exposure, either directly or indirectly experienced, novel therapeutic approaches and creative reflections can help patients find meaning and strength in a more complex view of life and one’s place in it. Thus, re-experiencing a moral injury and working through the pain of a new traumatic exposure can lead to resilience, growth, and a healing outcome.




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