Memory-Structuring Intervention (MSI) for PTSD

A study was done in Israel with people who experienced motor vehicle accidents to test if a memory-structuring intervention (MSI) could prevent the development or severity of PTSD symptoms.

MSI was based on theories and empirical findings summarized in the previous post.  The components of the intervention are summarized below:

Time sections
A therapist approaches the trauma survivor with a set of predetermined time sections in mind:

• the hours before the accident
• the first minutes of driving
• the accident
• the arrival of medical assistance
• arrival at the hospital

Listening to and clarifying patient’s details
The therapist actively listens to and writes down details of the patient’s story, while clarifying factual, sensory, and affective details.  For example:

Patient: I shouted after falling
Therapist: Did you shout because of pain at that moment?
Patient:   I shouted because my back hurt me

Details are noted by the therapist in their corresponding time sections, together with precise labels for thoughts and feelings, to enhance structure and cognitive processing of sensory/affective reactions.

Memory structuring
The therapist repeats the trauma narrative in an organized, labeled, and logical manner, adding initial implications for the patient’s life (insight).

Patient’s structured description
The patient describes the traumatic event in the same structured, labeled, and logical manner as the therapist did. At this point, patients usually add further details, describe the event in a more objective “journalistic” manner, and appear less aroused.

Practice structured description
Until the subsequent session, the patient is asked to practice telling friends or family members the structured version of the traumatic event, to enhance the attempted memory shift.

Rehearsal with therapist
In the second meeting, patients practiced for the last time disclosing the traumatic memory in its structured manner. Finally, the patient was taught about the importance of and asked about his/her social support (a predictor of delayed PTSD in motor vehicle accidents).

This may just sound like your average exposure therapy sessions, but it should be noted that these were done via telephone and over just two sessions. Furthermore, at follow-up, MSI patients (as compared to those that received supportive listening-type telephone counseling) reported significantly less frequent total PTSD symptoms, less frequent intrusion symptoms (reliving the event) and less frequent arousal symptoms.  No significant differences were found in relation to avoidance symptoms.

Once again, the magic is in telling the story, over and over, with structure, order, coherence, meaning, organization, details, noting thoughts and feelings.  Moving the memory from the right part of the brain (sensory and affective side) to the left part of the brain (logic and language side).

This seems to help whether we are talking about motor vehicle accidents, childhood attachment trauma or any other type of trauma.  It reminds me that High School English teachers tend to be our favorite.  I wonder if some of that might be due to the fact that the writing and storytelling about our life experiences we learned to do in their classes  - structured, coherent, with plenty of sensory details - helped heal our brain and retrieve our souls.

From: Translating Research Findings to PTSD Prevention: Results of a Randomized–Controlled Pilot Study by Yori Gidron, Reuven Gal, Sara Freedman, Irit Twiser, Ari Lauden, Yoram Snir, Jonathan Benjamin in Journal of Traumatic Stress, Vol. 14, No. 4, 2001.