I'm still a bit confused - sorry if I don't sound earnest.

This drug eliminates the amount of time you think about a past event. This is pitched as good. Is the model that thinking about something is bad but talking about something is good? What if talking about something changes how or when you think about something? As you said with your co-worker example (which I realize is not PTSD levels) I think it could be pretty easily argued that fixating about your current situation is actually contributing to negative mental processes.

I have done therapy for specific issues and it worked for me - but nonetheless still dont see some contradictions between therapy and a pill that makes you think about something less.

This is a pre-clinical study that is designed to model an aspect of a "traumatic" event and assess how the treatment condition (hydrocortisone) can affect behavior. Moreover, this experiment is designed to probe the effects of trauma in the moments immediately after the traumatic event, where the stress response is initiated. This is likely the period of time where the most synaptic changes occur. Of course, this paper doesn't directly posit that forgetting thoughts associated with trauma is therapeutic, as that would require an empirical study that include patients with PTSD.

Also, the purpose of therapy, such as CBT, is not to fixate on one's current situation, but be able to unlearn feelings of trauma / anxiety from the event. This is done by engaging with a trained professional who can help the patient carefully break down their thoughts and feelings. Reflecting on a traumatic situation with a partner is different from reflecting on a traumatic situation amongst oneself.

I think there's a difference between (mediated) constructive reflection with the goal of processing an event, and Repetitive Negative Thoughts (RNT) about an event. The latter can of course have long lasting negative effects.

I think it's probably better to reflect on and process a _potentially_ traumatic event, than it is to repress or otherwise force yourself to forget it. But either of those is preferable to dwelling on it and spiraling in negativity.

Perhaps this is just a matter of degree. For really bad trauma (mass casualty, etc) it's probably good to have stronger tools available.

Much of the therapy I have been involved with has been arranged not just around dealing with negative thoughts, but more fundamentally getting into a position where you can approach negative thoughts without moving into a triggered state.

I think I get what you're saying; I could, for instance, just drink a lot every day to ignore a variety of ideas, but it's much healthier in the long run to deal with those ideas directly.

Unfortunately, the reason why there are so many palliative coping strategies is that unless a person is in a state where they can examine those uncomfortable thoughts, then it's just creating more harm and the person isn't able to deal with the issue. That in turn often leads to the maladaptive coping that leads people into therapy in the first place.

So a common therapeutic goal getting people to a point where they can first recognize that they are in an upset state, second calm themselves without totally disengaging from the event and, then (if possible) work on whatever thoughts or events led to becoming upset in that manner.

That work is contingent on the first two parts of that; palliative care to help people get into a place where they can do the first two things without engaging in more harmful types of coping strategies (drinking, for instance) seems like a reasonable method.

Right. I think I mostly agree with you. Perhaps I just think involuntary/intrusive thoughts in the study is a bit of a loaded term. These words to me sound implicitly negative - but unless they resulted in serious negative behaviors then I don't see why they should be considered such a negative. From my own perspective it seems that even if my own thinking about something a lot may not be as effective as therapy or meditation, thinking about something does help process it and does help you come to a similar calmness about it.

The drug in the paper, to me, seems more like the coping strategies you talk about but without the other physical harms. Like what if alcohol made you not think about something but actually kept your physical and mental health the same/stable? Would that be desired? Isn't that what this drug is hoping to achieve?

It eliminates the times you uncontrollably think about a past event - note that voluntary recall isn't affected. So it's saying that this lets you process the trauma in a controlled environment when you're in a position to deal with it, but otherwise resume a life that isn't interrupted or dominated by it.

And there's a big difference between suffering from intrusive thoughts about a traumatic experience, and talking about that experience voluntarily. The former is stressful; the latter is therapeutic.

I guess my skepticism of this is a bit unpopular - but the way they measured intrusive thoughts is whether or not the people mentioned the traumatic film they saw in a journal for a week.

It seems plausible to that thinking (even if involuntary) about any other traumatic memory may result in short term stress but in the long run help you process it and be healthy? Like in my own experience thinking about something a lot on my own is part of therapy - since I really think about how I explain the situation and what really happened - so I guess I'm skeptical that not thinking of something is actually good for mental health in the long run even if in the short run it works.

> I guess my skepticism of this is a bit unpopular - but the way they measured intrusive thoughts is whether or not the people mentioned the traumatic film they saw in a journal for a week.

That's a fair criticism. Doing research on real is tough -- everyone's experience is a little different, and is colored by their personal history -- and it'd be wildly unethical to put test subjects through an in-person experience stressful enough to induce lasting PTSD. Some studies, like the Tetris intervention one I linked elsewhere [1], used real trauma patients; others, like this one, have to rely on stress simulants like a violent film.

I will note, however, that Irréversible [2] -- the film this study used excerpts from -- is exceptionally violent. It's not a run-of-the-mill action film. One of the scenes the study probably used graphically depicts a man being beaten to death with a fire extinguisher.

[1]: https://www.psych.ox.ac.uk/news/tetris-used-to-prevent-post-...

[2]: https://en.wikipedia.org/wiki/Irr%C3%A9versible

Yeah. Perhaps its a bit unfair to pick out in the weeds details of the study.

I guess maybe the core of my confusion comes with the term "intrusive" or "involuntary" memory. To me, in reference to PTSD, this sounds extremely negative. But perhaps you were in a situation where you saw someone die, perhaps even someone you know, should the goal be to only think about these things in therapy or when you sit down to meditate? Is involuntary/intrusive thoughts on these bad so long as it doesnt have major effects on your stability?

Not nearly as traumatic - but when I went through my last break-up I thought about it non-stop for a few weeks. I was able to get through my work and keep up social engagements fine, but otherwise it consumed me. Would it have been better to only think about the situation in therapy sessions and allotted meditation time? Maybe? But I'm not that sure on that I probably needed a few weeks of internal "involuntary" struggle in order to be free of the negative thoughts around it going forward.

I guess for me the answer is that if your brain is thinking about something, even if it seems a bit disorganized, you are still processing it on your own time and the short term benefits of not thinking about it then may not actually be good for your long term. Though perhaps this runs counter to established literature I'm not aware of.

People routinely cross the threshold from thinking about something and processing it on their own time into what's called rumination, which is a nonproductive recurrence of said thoughts in which no real processing is done. Managing this kind of symptom is often the first step in successful long-term recovery; the goal of psychiatry is never just to sweep problems under the rug instead of helping patients process their world effectively.

Oh, I'm quite aware. I spent most of my life dealing with them. Psychosis, paranoia, and flashbacks are a bitch.

I have been and I am still dealing with intrusive thoughts for the past year. I am still unable to talk about most of them or recall them voluntarily - only the rough circumstances, but not the actual situation(s). For the first months after the event, I was unable to drive a car or a bike because the thoughts come with body reactions: muscle spasms, blurred vision, loss of hearing, etc. It is still somewhat dangerous for me to drive because my hands or feet can suddenly cramp and I am unable to release. Intrusions can happen suddenly and without a trigger. Most of my intrusions now come with no "attached memory" at all, just emotions and very painful body reactions. I am still mostly unable to participate in "ordinary life" because you have a lot of situations where you don't want to have that happen around other people, because their reactions will really not help you "feel safe", which then contributes to retraumatization.

I still have this multiple times, every day, even with 2-3x therapy per week since a year.

This is nothing like "recalling a memory". Also, since I am unable to clearly express what I have witnessed/experienced, talking to "ordinary people" (e.g. most my friends) about it is mostly met with reactions that really don't help at all.