How RTM works is rooted in part in the malleable nature of memory. Research tells us that memories are less fixed than we think they are. Some fade with time, becoming less distinct or specific, while others are altered by emotions and attitudes.

Veterans who have experienced combat tend to believe that their wartime memories, particularly the difficult ones, will remain vividly fixed in their minds. But memories can be modulated and modified. The emotional punch of certain memories, particularly fear and apprehension, can be tempered, reduced, and even eliminated.

RTM uses the brain’s ability to diminish a traumatic memory’s impact by asking an individual to imagine a movie screen. A therapist then guides the client through a short “movie” of a neutral event, imagining the images in black and white, then running at different speeds and in reverse until the client is comfortable watching the imaginary images.

From there, a therapist moves on to images of the client’s actual traumatic event, but from a dissociated view, as if simply looking on as a disinterested observer, not a direct participant.

The final step is defined by a client’s ability to remember a traumatic event without its original anxiety-provoking impact.

“After his second RTM session, Mike Moreno said, “I reenacted the event in the third person. Me, looking at myself, watching the event unfold. We did this several times, putting less and less emphasis on the gory details each time. At the end of this session, I teared up. The event had gone from an emotional level ten to a three.”

In the last session, “we changed from reenacting the event in the third person to me watching the event unfold from a safe place before the firefight, to a safe place after the firefight, looking at those horrible things that happened during the battle as still images in a fast-running black-and-white slide show. By the end of the session, the ambush that had been a level ten for me for so many years had become a zero.”

Despite extensive documentation supporting RTM’s usefulness, however, the VA recently announced that the evidence on RTM “was insufficient for making a recommendation.” Although positive, the evidence was judged to be “very low quality.” The statement went on to say that the VA’s Office of Research and Development does not have “any current or pending research activities in RTM,” and that the VA’s National Center for PTSD was “not conducting or planning to conduct research on RTM at this time.”

The good news is that RTM is available through the VA’s Vet Centers nationwide and in private and public settings. Some 350 trained and certified RTM practitioners across the country are listed on The Research and Recognition Project’s online locator.

Frank Bourke has done more than a hundred RTM demonstrations for VIPs and leaders in the military and government. He recently met with the Surgeon Generals of the service branches and the Commandant of the Marine Corps and their staffs.

“Essentially the conclusion was that the service branches and the Defense Health Agency want to incorporate this therapy. We need to keep doing research, keep improving the protocol as it goes forward, and adapt it to other forms of PTSD,” Bourke said. “What I’m attempting to do is establish a research institute that will ensure fidelity to the treatment and do it all in a fashion that is genuinely objective.”

SECOND OPINION

BY Richard Currey

With the emergence of new treatments for any medical condition, especially those promising extraordinary results, some degree of caution is warranted.

“People sometimes come to VVA to ask us to formally support a particular approach to treating PTSD,” said Tom Hall, who chairs the National PTSD and Substance Abuse Committee. “When they do, I tell them Vietnam Veterans of America is not a research organization and we do not conduct scientific studies. Plus, VVA cannot officially endorse any treatment before it’s fully vetted and becomes a standard treatment that VA offers.”

With that caveat, Hall agreed that the PTSD therapy known as Reconsolidation of Traumatic Memories is a promising treatment option.

“VVA encourages more research into RTM, as well as other newer PTSD treatments,” Hall said, “but PTSD is such a variable condition, marked by so many symptoms that manifest differently from one individual to another, that it’s unlikely that any single treatment will be a silver bullet. So far, at least, no specific treatment has worked for everybody, no matter how promising that therapy seemed to be in early studies.”

Hall went on to say that one of the most important things in any type of PTSD research is sample size. “In other words, how many people were in the group that received the treatment? If it was five, and they all experienced significant improvement, that’s interesting. If it was fifty, that starts to be more persuasive. But it typically needs to get into the hundreds before the VA will be convinced.”

This is one of the bars that RTM therapy still needs to clear, Hall said, “to get moved into the VA’s service package of PTSD treatments.”

Dr. Tom Hall

While Hall welcomes the development of more treatment alternatives, he noted that “nothing’s 100 percent. If RTM turns out to be a therapy that produces a high recovery rate as studies so far point to, and if further evidence definitively confirms that this high recovery is sustainable, researchers can say with confidence that it is an effective treatment that deserves widespread use among veterans—or anybody—battling PTSD.”

RTM continues to be considered an “emerging” therapy as research continues, Hall said, and the VA – as well as VVA – will be closely following the outcomes of that research.