Midway through the two-week immersive Road Home Program when veterans and service members have told their stories of their traumas several times and more details and context emerge with each telling, sometimes the "hot spots" surface. These hot spots are the parts of the trauma that are particularly provocative and upsetting, the memories and emotions that are keeping the person stuck. By focusing on those hot spots, clinicians can help accelerate the therapy and move the person toward healing.
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By this time the story of the trauma has been told several times. And I think from where I sit as a clinician, what’s interesting is that the story often gets more complex, there’s new memories that emerge or new details that kind of get woven into the story. There’s just more context for the memory. So, this would occur in the midpoint of treatment. Now, around this time as well the veteran’s kind of starting to notice it was really difficult to tell the story at first. It was very emotional, very raw. But the more they tell it, the easier it becomes in a way. And so, one thing we can do in order to enhance and accelerate the treatment is focus on so-called hotspots. So, if there are parts of the story that are particularly provocative or upsetting, we might have a person identify and focus only on those parts of treatment. Because it’s not the whole story, or the whole experience of the trauma that’s as upsetting anymore, but we want to focus on what are the things that are really holding that person back and impeding their recovery. It might be the moment where maybe your buddy was kind of hit during a firefight and it might be sort of the moment where they pass in your arms. Or it might be sort of the flash of light right before an IED. It might be particularly intense moments in a firefight. It might be, you know, particularly violent moments during a rape, something like that. It is difficult to hear these traumas. And I think what has sustained me professionally during this work is knowing the kinds of improvements that can result.
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Brian Klassen, Ph.D., is the Associate Clinical Director for The Road Home Program: The National Center of Excellence for Veterans and Their Families at Rush University in Chicago, Illinois. Brian spent his formative years training at the Jesse Brown VA Medical Center, completing rotations in chronic pain management, residential substance use disorder treatment, and PTSD. Brian has special expertise in providing front-line treatments for PTSD, including Prolonged Exposure and Cognitive Processing Therapy.