Notes on therapy for Perpetration-induced traumatic stress There is also a page on a basic explanation, a page on  PITS in world literature, a page on PITS in personal stories, and a bibliography. Understanding the universality of the experience  “I saw many clients come to our inpatient program thinking that they were alone in their pain. They judged themselves uniquely crazy, weak, and/or cowardly for having had problems, such as flashbacks, fearfulness, and rage, in civilian life after their military experience. There was some genuine relief that came from seeing that others had these problems, even if the problems continued.” Lipke, H. (2000). EMDR and psychotherapy integration. Boca Raton, FL: CRC Press, p. ii   “In the therapy group, especially in the early stages, the disconfirmation of a patient’s feelings of uniqueness is a powerful source of relief. After hearing other members disclose concerns similar to their own, patients report feeling more in touch with the world.” Yalom, I. (1995). The theory and practice of group psychotherapy. New York: Basic Books knowledge of patterns     Pattern Differences for Those Who Said Yes on Having Killed (from discriminant function analyses)                          Especially high:                                           Also high:                          violent outbursts                                          hyperarousal                          intrusive symptoms                                      alienation                                                                                              sense of disintegration                                               Information taken from:   MacNair, R. M. (2002). Perpetration-Induced Traumatic Stress: The psychological consequences of killing. Westport,    CT: Praeger Publishers Eye Movement Desensitization and Reprocessing (Emdr)•          “This client said that his worst traumatic experience had to do with the death of some civilians for which he believed he was responsible. As the EMD therapy session unfolded, this veteran first reported decreased anxiety, as had the first veteran. Suddenly, he became upset and asked that we stop treatment. He went out of the therapy room with another staff member to calm down. When he returned he said that, as he became more comfortable with the memory, he got scared. He believed that he had made a “spiritual deal” – that if he stopped suffering, retribution would be taken against his family for the wrong he believed he had done.” (Lipke, 2000, p. v)  “I have had many clients who recall engaging in some bloody activity who are dumbfounded about why they would do such a thing. During the course of treatment, they then recall that their self-mortifying deed followed soon after some horrible loss of their own, a connection they had not realized since the event occurred.” (Lipke, 2000, p. 53) Traditions of Atonement and Bearing Witness          "alternative strategies . . . [include] exploring ways of making reparations and bearing witness" (p. 475) Foa, E. B., Meadows, E. A. (1997). Psychosocial treatments for posttraumatic stress disorder: A critical review. Annual Review of Psychology, 48, 449-480.   “Atonement, repentance and forgiveness, bearing witness, and re-identifying one's self as a different person than the one who did the killing (as in being "born again") have been suggested in many verbal discussions with therapists. These have been some of the responses of the human community in diverse cultures and through many historical periods to the common phenomenon of dealing with killing. They have remained because of extensive experience that they are, in fact, helpful.” MacNair, R. M. (2002). Perpetration-Induced Traumatic Stress: The psychological consequences of killing. Westport, CT: Praeger Publishers, p. 92 Therapeutic Stories     I do not know of any studies yet on this, but it seems like a promising area to explore. Counter-indicated: Flooding/Prolonged Exposure   "In particular, PTSD sufferers whose traumatic memories are about being perpetrators rather than victims may not benefit from [Prolonged Exposure as a treatment] and perhaps will even deteriorate from such treatment" (Foa and Meadows, 1997, p. 475).   The article they cite is a set of six case studies which point out times when the flooding technique, involving intense reminders of the trauma for the purpose of desensitization, seemed to be counterproductive: Pitman, R. K., Altman, B., Greenwald, E., Longpre, R. E., Macklin, M. L., Poire, R. E.,  & Steketee, G. S. (1991). Psychiatric complications during flooding therapy for posttraumatic stress disorder. Journal of Clinical Psychiatry, 52, 17-20. For comments or questions, or to add other sources, please contact Rachel MacNair at admin@rachelmacnair.com