The Last Word On Nothing

Most scientists are reluctant to talk about “curing” mental illness, and rightly so. The mountain is too steep: These disorders have a range of genetic and environmental causes, and symptoms vary widely from person to person. But for post-traumatic stress disorder (PTSD) — in which people are haunted for months or years by memories of a life-threatening event — that framework is all wrong.

So says The Time Cure, a book out later this month claiming that people with PTSD can find long-lasting relief by simply re-framing their concept of time. The authors outline a new clinical approach, dubbed Time Perspective Therapy or TPT, which they say is far more effective than any other treatment.

The book includes a lot of common-sense advice: Focus on good rather than unpleasant memories, find enjoyable hobbies, fraternize with a supportive community, make realistic goals. Following these simple directives would no doubt help many people, sick or not, improve their lives. Still, given the millions of people who suffer from PTSD, heralding a cure seems an act of hubris — especially when the evidence is limited to a small (and not peer-reviewed) clinical trial and more than 100 pages of poignant personal stories.

One of the authors, Philip Zimbardo, became super-famous in 1971 with his Stanford Prison Experiment, in which volunteers pretending to be guards became cruel while those playing prisoners became severely depressed. Since then, Zimbardo has turned his attention to the way we perceive time.

As he described in The Time Paradox, released in 2008, Zimbardo’s research suggests that each of us has a biased time perspective. Some are stuck in the present, reveling — or stewing — in their current sensory experience with no sense that their actions will matter later on. This is the perspective in which he was raised, he says, by immigrant parents who never made it out of poverty. But other people, like the typical Stanford undergraduate, are oriented toward the future, constantly making to-do lists or fretting about how to make the best possible decision. Happiness, Zimbardo says, means finding a healthy balance.

After The Time Paradox came out, Hawaiian therapists Richard and Rosemary Sword told Zimbardo that they had successfully applied many of these principles to their clients, mostly war veterans with PTSD. Zimbardo wanted to see “hard data.” So in 2009 the trio began a study in which 30 of the Swords’ clients, all veterans, took an array of psychological tests — including the Zimbardo Time Perspective Inventory, a questionnaire that quantifies how much you focus on the past, present or future — before, during and after TPT.

In the new book, the Swords and Zimbardo present what appear to be stunning results from this pilot study. After six months of therapy, 89 percent of participants showed fewer symptoms of depression, 70 percent had less anxiety and 52 percent showed less trauma. The authors also explain how to carry out TPT and describe in detail the success stories of 15 people who tried it.

Take, for example, Aki, an 88-year-old Japanese American who suffered from flashbacks and insomnia six decades after fighting in the front lines in Germany during World War II. Aki was fixated on the night in 1945 when all of the other soldiers at his base camp were accidentally killed by American friendly fire.

A big part of TPT treatment is framing. Rather than use the charged words of “anxiety” and “depression,” for instance, the authors prefer to describe clients like Aki as “stuck in the past negative.” Rather than calling PTSD a mental illness, which seems oppressive and hopeless, they call it a mental injury.

In Aki’s first TPT session, he was told that whenever his mind took him to that awful night, he should think instead of the happy times with his war buddies, like the day they were camped near an onion field and made a foul-tasting onion soup. In the second session, the therapists nudged him to join a morning meeting of other local vets. In later sessions, they focused on how he could improve his future, by walking three miles a day and planning for a veterans convention in Las Vegas.

Aki’s therapy, we learn, was “surprisingly easy for him to do,” and was far more effective than the years he had spent using the current gold-standard treatment for PTSD, cognitive behavioral therapy or CBT. With CBT, the patient evaluates specific thoughts and feelings, ferrets out those that aren’t rational, and sets goals for the future. Sounds an awful lot like TPT, no?

And there lies the most troubling aspect of an otherwise harmless self-help book. The authors repeatedly and explicitly claim that TPT is more effective than CBT. Not only do they fail to fully explain how the two therapies are different, but they dismiss the fact that several large and placebo-controlled clinical trials have found that for a subset of people with PTSD, CBT works.

In the introduction, Zimbardo admits that he would have preferred to hold the book until conducting a formal study, but didn’t because he lacked the necessary funding of several million dollars. In choosing to publish now, he may create a buzz around this new therapy, and that buzz may lead him to funding and, eventually, to solid evidence for TPT. But in the meantime, the book could just as easily push people with PTSD to choose an untested treatment over a proven one. Only time will tell, I suppose.

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Photo of onion field by Dick Thomas Johnson