Treating PTSD and Addiction with Traumatic Incident Reduction (TIR)
It’s estimated that around 70 percent of Americans have experienced a trauma in their lifetime, and this can significantly reduce quality of life. Trauma Incident Reduction is an effective therapy for treating the effects of trauma, including post-traumatic stress disorder, or PTSD, which often results from trauma and frequently co-occurs with addiction.
Trauma occurs when someone experiences or witnesses a terrifying or terrible event, such as violence, sexual assault, combat or a natural disaster. Adulthood trauma and childhood trauma-such as emotional or sexual abuse, neglect or living with violence in the household- have far-reaching consequences. Experiencing a trauma can affect brain function and behavior.
How Trauma Affects the Brain: PTSD
Post-traumatic stress disorder, or PTSD, is a psychiatric disorder that causes a range of symptoms that make it difficult to function in healthy, normal ways. These symptoms dramatically interfere with quality of life and feelings of well-being, and they often lead to substance abuse as a coping mechanism.
More than 13 million Americans have PTSD at any given time. Symptoms of PTSD typically begin within three months of a traumatic event, although they may occur immediately afterwards or months or even years later. Symptoms of PTSD fall into four categories.
Re-Experiencing Symptoms in PTSD
Re-experiencing symptoms interfere with everyday functioning. They can be triggered by a thought, emotion or situation. Symptoms associated with re-experiencing include:
- Flashbacks, which involves re-living the traumatic event in a very real way that can cause an increase in heart rate or profuse sweating
- Nightmares, which may occur nightly and affect the ability or desire to sleep
- Persistent frightening thoughts that are difficult to stop
Avoidance Symptoms in PTSD
Avoidance symptoms interfere with daily routines and involve avoiding the places, people, events or objects that serve as reminders of the trauma. Avoidance symptoms also include suppressing or avoiding thoughts or emotions related to the traumatic event.
Arousal and Reactivity Symptoms in PTSD
Arousal and reactivity symptoms of PTSD are constant and not necessarily triggered by reminders of the traumatic event. However, they make it difficult for people with PTSD to function normally, interfering with the ability to concentrate, sleep, eat or perform normal daily activities. Arousal and reactivity symptoms include:
- Being startled or frightened easily
- Having near-constant feelings of impending doom or chronic stress
- Sleeping difficulties, including insomnia, frequent waking or difficulty waking up
- Feelings of intense anger or sudden angry outbursts
Cognition and Mood Symptoms in PTSD
The symptoms associated with PTSD that are related to mood and cognition often leave people feeling detached and isolated from others, and they can be deeply unsettling. These symptoms include:
- A loss of memory about key events of the trauma
- Deeply negative thoughts about yourself or the world
- Feelings of shame, guilt or blame
- Losing interest in activities previously enjoyed
PTSD frequently co-occurs with anxiety or depression and commonly leads to substance abuse as a way to cope with frightening memories, nightmares, insomnia, cyclical thoughts and negative emotions that occur with PTSD.
Trauma, PTSD and Addiction Among Children, Women, Men and Veterans
Children and Teens
Exposure to trauma in childhood changes the structures and functions of the developing brain, according to a study published in the journal Depression and Anxiety.1 It often leads to cognitive problems and mental illnesses down the road, including major depression and bipolar disorder. Childhood trauma dramatically increases the risk of substance abuse and addiction. According to a study published in the American Journal of Psychiatry, 24 percent of males and 45 percent of females aged 15 to 19 who were in treatment for a substance use disorder had a lifetime history of PTSD- five times higher than the general adolescent population.2 Nearly 60 percent of young people with PTSD will develop a substance use disorder.
Sexual assault is the most common cause of PTSD in women. One study found that 94 percent of women experience symptoms of PTSD within the first two weeks of a sexual assault. A study in the journal Psychiatric Services reports that up to 80 percent of women who are in treatment for a substance use disorder have a history of trauma, most commonly sexual assault or physical abuse.3
While women are twice as likely as men to have a lifetime history of PTSD, men are less likely to seek help for PTSD and addiction, largely due to societal pressures to be “strong.” Men are also more likely than women to self-medicate PTSD symptoms with drugs or alcohol. When they do seek treatment for PTSD or a substance use disorder, men tend to have more difficulties than women engaging in therapy. They may have problems expressing emotions and communicating honestly about their traumatic experiences.
Veterans have a high prevalence of PTSD due to combat and sexual assault. Around 23 percent of female soldiers report being the victim of sexual assault while serving in the military, according to the U.S. Department of Veterans Affairs.4 Up to 75 percent of all veterans who have experienced combat or sexual trauma report having problematic drinking patterns.
Substance Abuse in PTSD
Substance abuse is defined as using drugs or alcohol in a way that causes problems in your life, and it can lead to addiction, which is characterized by compulsive drug or alcohol abuse despite the negative consequences it causes. Once someone becomes addicted, good intentions and willpower are rarely enough to end the substance abuse, according to the National Institute on Drug Abuse. Professional help is almost always needed to help individuals work through the traumas, chronic stress and mental illnesses that commonly occur with addiction.
Traumatic Incident Reduction and How it Helps
Traumatic Incident Reduction, or TIR, is a therapy used to reduce the negative effects of a past trauma on your life. It’s especially helpful for people who have a specific trauma that has affected their life, even if a formal PTSD diagnosis has not been made. It’s effective for people who find themselves reacting inappropriately to certain situations or experiencing negative emotions and who believe a past trauma may be responsible.
According to the Traumatic Incident Reduction Association, when it’s correctly applied, Traumatic Incident Reduction results in the complete and permanent elimination of PTSD symptoms.5 Typically, TIR clients also gain valuable personal insights, often spontaneously, that help transform their lives.
How TIR Works
Traumatic Incident Reduction therapy can be regarded as a type of exposure technique. Its goal is to help clients become more aware of a traumatic event in order to desensitize them, leading the client to dis-identify with the thoughts, emotions and other inner experiences resulting from the trauma. The client begins to see the trauma and inner experiences as separate from the self. This can occur with just one session, or it can take five or more sessions, depending on the severity of the trauma and how many traumas are being addressed.
A Traumatic Incident Reduction therapy session typically lasts between one and two hours. During TIR, the client is made to feel safe and secure in the session, which starts with an assessment to determine what the ideal outcome will be. Then, while the therapist listens without distractions, interjections or judgments, the client re-tells and re-experiences the trauma to completion, then does it again, and again. During the re-telling, clients examine how their emotions and behaviors interact and how the trauma has affected them and the people in their lives.
With each re-telling, repressed memories may arise, and details may emerge that were suppressed. In the process, the client releases painful emotions and negative thought patterns and releases resistance to re-experiencing it. The “end point” of Traumatic Incident Reduction occurs when clients feel their attention become unattached to the trauma and the trauma loses its ability to negatively affect them. They typically experience one or more important insights or realizations that can be further explored in another session.
Traumatic Incident Reduction helps people eliminate self-harm behaviors, develop healthy, trusting relationships, gain control over their symptoms and achieve a high level of self-care.
The Effectiveness of Traumatic Incident Reduction
A comprehensive study of TIR conducted by researchers at the University of Alabama and Florida State University found that it:6
- Significantly reduced depression immediately afterwards, which was maintained at the three-month follow-up
- Significantly reduced feelings of anxiety, which was also maintained at the three-month follow-up
- Reduced symptoms of PTSD, including intrusive thoughts, anxiety, avoidance and hyper-arousal
During Traumatic Incident Reduction in an addiction treatment setting, individuals uncover the events and emotions that have led to the substance abuse and addiction. Improved symptoms of PTSD helps remove the need to self-medicate these symptoms with drugs or alcohol.
When used along with traditional therapies like cognitive-behavioral therapy, Traumatic Incident Reduction therapy can help people make meaningful connections between their thoughts and behaviors and improve their emotional health. TIR can help people become self-reliant and improve their life’s quality and balance for a happier, healthier and more productive life.